Provider Demographics
NPI:1083642920
Name:RANDAL, H BROOK (MD)
Entity Type:Individual
Prefix:
First Name:H
Middle Name:BROOK
Last Name:RANDAL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:510 PARK BLVD
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78751-4313
Mailing Address - Country:US
Mailing Address - Phone:512-467-9278
Mailing Address - Fax:
Practice Address - Street 1:3003 BEE CAVES ROAD
Practice Address - Street 2:AUSTIN SURGICAL HOSPITAL
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78746-5542
Practice Address - Country:US
Practice Address - Phone:512-314-3800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2008-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG3943207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX138107114Medicaid
TX8D0346Medicare ID - Type Unspecified
TX138107114Medicaid
TXD67575Medicare UPIN