Individual
BERNARD C RANDOLPH JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
12855 NORTH FORTY DRIVE, SUITE 125, ST LOUIS, MO 63141
(314) 966-0111
(314) 966-1023
Mailing address
12813 FLUSHING MEADOWS DRIVE, SUITE 210, ST. LOUIS, MO 63131
(314) 966-0111
(314) 966-1023
Taxonomy
Speciality
Code
Description
License number
State
208100000X
Physical Medicine & Rehabilitation Physician
Primary
R6G60
MO
Other
Enumeration date
09/21/2005
Last updated
10/21/2011
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