Individual
KAREN A. RANDALL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
D.O.
Contact information
Practice address
400 W 16TH ST, PUEBLO, CO 81003-2745
(719) 584-4306
(719) 595-7886
Mailing address
400 W 16TH ST, PUEBLO, CO 81003-2745
(719) 584-4306
(719) 595-7886
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
5101010551
MI
207P00000X
Emergency Medicine Physician
DR.0051971
CO
207Q00000X
Family Medicine Physician
5101010551
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
010H262530
BLUE CROSS-BLUE CROSS
—
05
—
327179611
—
MI
01
—
KR010551
COMMERCIAL-COMMERCIAL NUMBER
—
Enumeration date
11/17/2006
Last updated
11/11/2013
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