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Individual

DR. RANDALL LEE FUNNAMARK JR.

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
DO

Contact information

Practice address
10624 S EASTERN AVE # A-955, HENDERSON, NV 89052-2982
(702) 800-5393
(702) 407-7016
Mailing address
10624 S EASTERN AVE # A-955, HENDERSON, NV 89052-2982
(702) 800-5393
(702) 407-7016

Taxonomy

Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
DO3644
NV
207R00000X
Internal Medicine Physician
SL1722
NV

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
1992379531
NV
Enumeration date
05/18/2021
Last updated
06/24/2024
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