Provider Demographics
NPI:1124002175
Name:RANDALL, M. BARRY (MD)
Entity Type:Individual
Prefix:
First Name:M.
Middle Name:BARRY
Last Name:RANDALL
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 1:1407 UNION AVE
Mailing Address - Street 2:SUITE 700
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38104-3627
Mailing Address - Country:US
Mailing Address - Phone:901-866-8375
Mailing Address - Fax:901-302-2360
Practice Address - Street 1:930 MADISON AVE
Practice Address - Street 2:SUITE 890
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38103-3410
Practice Address - Country:US
Practice Address - Phone:901-866-8834
Practice Address - Fax:901-302-2834
Is Sole Proprietor?:No
Enumeration Date:2005-12-02
Last Update Date:2018-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN029321207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS0121423Medicaid
AR133395001Medicaid
TN1532078Medicaid
TND92823Medicare UPIN
TN1532078Medicaid