Provider Demographics
NPI:1063443703
Name:CRIM, RANDALL W (MD)
Entity Type:Individual
Prefix:
First Name:RANDALL
Middle Name:W
Last Name:CRIM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:11551 FOREST CENTRAL DR
Mailing Address - Street 2:SUITE 133
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75243-3920
Mailing Address - Country:US
Mailing Address - Phone:214-343-8565
Mailing Address - Fax:214-343-3689
Practice Address - Street 1:2001 N MACARTHUR BLVD
Practice Address - Street 2:SUITE 750
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75061-2256
Practice Address - Country:US
Practice Address - Phone:972-759-2040
Practice Address - Fax:972-759-2045
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2021-03-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXH1941208C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX103840801Medicaid
TX103840803Medicaid
TX83W252Medicare PIN
TX280000514Medicare PIN