Provider Demographics
NPI:1124011507
Name:JAMES, RANDOLPH LEE (MD)
Entity Type:Individual
Prefix:
First Name:RANDOLPH
Middle Name:LEE
Last Name:JAMES
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 1:403 S BALDWIN ST
Mailing Address - Street 2:
Mailing Address - City:WOODLAND PARK
Mailing Address - State:CO
Mailing Address - Zip Code:80863-3154
Mailing Address - Country:US
Mailing Address - Phone:719-686-7776
Mailing Address - Fax:719-355-1927
Practice Address - Street 1:403 S BALDWIN STREET
Practice Address - Street 2:
Practice Address - City:WOODLAND PARK
Practice Address - State:CO
Practice Address - Zip Code:80863-8762
Practice Address - Country:US
Practice Address - Phone:719-686-7776
Practice Address - Fax:719-355-1927
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-31
Last Update Date:2012-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO45978207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO811674OtherMEMORIAL HOSPITAL