Provider Demographics
NPI:1114074051
Name:RANDOLPH, DAVID ALAN (MD, PHD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:ALAN
Last Name:RANDOLPH
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 55823
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35255
Mailing Address - Country:US
Mailing Address - Phone:205-996-2244
Mailing Address - Fax:205-996-2254
Practice Address - Street 1:619 SOUTH 19TH STREET
Practice Address - Street 2:NHB 525
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35294
Practice Address - Country:US
Practice Address - Phone:205-934-4680
Practice Address - Fax:205-934-3100
Is Sole Proprietor?:No
Enumeration Date:2007-01-04
Last Update Date:2007-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA790662080N0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080N0001XAllopathic & Osteopathic PhysiciansPediatricsNeonatal-Perinatal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL009910610Medicaid
AL08909026OtherMISSISSIPPI MEDICAID
AL515-42016OtherBC BS
AL009910610Medicaid