Individual
RANDALL R SOUTHARDS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
1000 N OAK AVE, MARSHFIELD, WI 54449-5703
(715) 387-5511
Mailing address
2845 GREENBRIER RD STE 320, PO BOX 8900, GREEN BAY, WI 54308-8900
(920) 288-8320
(920) 288-8325
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
1402
WI
363A00000X
Physician Assistant
PA9120374
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
41958200
—
WI
Enumeration date
06/14/2006
Last updated
09/17/2025
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