Provider Demographics
NPI:1063467447
Name:RAND, JOHN H (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:H
Last Name:RAND
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:80 HERREN HILL ROAD
Mailing Address - Street 2:STE D
Mailing Address - City:TALLASSEE
Mailing Address - State:AL
Mailing Address - Zip Code:36078
Mailing Address - Country:US
Mailing Address - Phone:334-283-3709
Mailing Address - Fax:334-283-3708
Practice Address - Street 1:80 HERREN HILL ROAD
Practice Address - Street 2:STE D
Practice Address - City:TALLASSEE
Practice Address - State:AL
Practice Address - Zip Code:36078
Practice Address - Country:US
Practice Address - Phone:334-283-3709
Practice Address - Fax:334-283-3708
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-23
Last Update Date:2010-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALMD5034207YX0905X
SCMD7394261QS1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207YX0905XAllopathic & Osteopathic PhysiciansOtolaryngologyOtolaryngology/Facial Plastic Surgery
No261QS1200XAmbulatory Health Care FacilitiesClinic/CenterSleep Disorder Diagnostic
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC073949Medicaid
SCGP3546Medicaid
AL009913154Medicaid
AL009913154Medicaid
SCC68865Medicare UPIN
SC073949Medicaid