Provider Demographics
NPI:1124015722
Name:REID, RANDALL JAMES (MD)
Entity Type:Individual
Prefix:MR
First Name:RANDALL
Middle Name:JAMES
Last Name:REID
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:13555 W. MCDOWELL RD
Mailing Address - Street 2:STE 205
Mailing Address - City:GOODYEAR
Mailing Address - State:AZ
Mailing Address - Zip Code:85395
Mailing Address - Country:US
Mailing Address - Phone:623-535-0740
Mailing Address - Fax:623-535-0741
Practice Address - Street 1:10815 W. MCDOWELL RD
Practice Address - Street 2:STE 301
Practice Address - City:AVONDALE
Practice Address - State:AZ
Practice Address - Zip Code:85392
Practice Address - Country:US
Practice Address - Phone:623-433-0106
Practice Address - Fax:623-433-0108
Is Sole Proprietor?:No
Enumeration Date:2005-09-29
Last Update Date:2014-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM2002-0095207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMF03258Medicare UPIN
16471849Medicare PIN