Provider Demographics
NPI:1144222514
Name:TUGGLE, RANDALL MORRIS (MD)
Entity Type:Individual
Prefix:
First Name:RANDALL
Middle Name:MORRIS
Last Name:TUGGLE
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 1:8906 SPANISH RIDGE AVE STE 202
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89148-1319
Mailing Address - Country:US
Mailing Address - Phone:702-330-3102
Mailing Address - Fax:702-912-4994
Practice Address - Street 1:8906 SPANISH RIDGE AVE STE 202
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89148-1319
Practice Address - Country:US
Practice Address - Phone:702-330-3102
Practice Address - Fax:702-912-4994
Is Sole Proprietor?:No
Enumeration Date:2005-08-15
Last Update Date:2020-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV5903207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV002002709Medicaid
NV002002709Medicaid
E34669Medicare UPIN
NV101484Medicare PIN
NVBA909Medicare PIN
NVV101484Medicare PIN