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Individual

RANDOLPH L. ROYSTER JR.

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
600 HOSPITAL DR, SUITE 10, CLYDE, NC 28721-8046
(828) 452-2320
(828) 456-4707
Mailing address
2234 COLONIAL BLVD, FORT MYERS, FL 33907-1412
(239) 931-7342
(239) 931-7385

Taxonomy

Speciality
Code
Description
License number
State
2085R0203X
Therapeutic Radiology Physician
Primary
19717
NC

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
1190948
GATEWAY HEALTH
FL
01
130TY
BCBS OF NC PROVIDER #
NC
01
24-00057
UTD. HLTHCR PROVIDER #
NC
01
4626651
AETNA PROVIDER NUMBER
NC
01
8770417002
CIGNA PROVIDER NUMBER
NC
05
89130TY
NC
01
92-0006817
RAILROAD MCARE PROVIDER #
NC
01
B4334
MEDCOST PROVIDER NUMBER
NC
Enumeration date
05/11/2006
Last updated
10/27/2016
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