Individual
DR. RANDAL CARL ANDERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
510 E STONER AVE, SHREVEPORT, LA 71101-4243
(318) 990-5322
Mailing address
1218 GALLEN RD, SANTA CLARA, UT 84765-1249
(319) 440-9737
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
M-9167
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
165862001
—
AR
01
—
P00428982
RAILROAD MEDICARE
AR
Enumeration date
05/12/2006
Last updated
03/01/2024
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