Individual
RANDALL SCOTT WHITESIDE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CP
Contact information
Practice address
1190 E MISSOURI AVE STE 190, PHOENIX, AZ 85014-2736
(602) 312-6605
(480) 212-5944
Mailing address
5347 E MOCKINGBIRD LN, PARADISE VALLEY, AZ 85253-2521
Taxonomy
Speciality
Code
Description
License number
State
224P00000X
Prosthetist
Primary
—
—
Other
Enumeration date
07/28/2017
Last updated
03/17/2018
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