Provider Demographics
NPI:1033356373
Name:RANDLE T. MIDDLETON MD, P.C
Entity Type:Organization
Organization Name:RANDLE T. MIDDLETON MD, P.C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:RANDLE
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:MIDDLTON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:256-882-7351
Mailing Address - Street 1:2089 CECIL ASHBURN DR SE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35802-2567
Mailing Address - Country:US
Mailing Address - Phone:256-882-7351
Mailing Address - Fax:256-489-2322
Practice Address - Street 1:2089 CECIL ASHBURN DR SE
Practice Address - Street 2:SUITE 101
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35802-2567
Practice Address - Country:US
Practice Address - Phone:256-882-7351
Practice Address - Fax:256-489-2322
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-08
Last Update Date:2012-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL18862207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL000038324OtherMEDICARE PROVIDER NUMBER
ALF60057Medicare UPIN