Individual
RANDY DEAN SECRIST
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
3949 BROWNING PL, RALEIGH, NC 27609-6504
(919) 787-8221
(919) 789-4461
Mailing address
PO BOX 19368, RALEIGH, NC 27619-9368
(919) 787-8221
(919) 789-4461
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
32854
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
16-55677
UNITED HEALTHCARE
NC
01
—
16-56816
UNITED HEALTHCARE
NC
01
—
183105
MEDCOST
NC
01
—
19-60554
UNITED HEALTHCARE
NC
01
—
75181
BLUECROSS BLUESHIELD
NC
05
—
8975181
—
NC
01
—
A3436
MEDCOST
NC
01
—
A3710
MEDCOST
NC
Enumeration date
06/07/2006
Last updated
07/08/2007
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