Provider Demographics
NPI:1154319556
Name:HURD, RANDALL CHARLES (MD)
Entity Type:Individual
Prefix:
First Name:RANDALL
Middle Name:CHARLES
Last Name:HURD
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:MSU, MANKATO
Mailing Address - Street 2:21 CARKOSKI COMMONS
Mailing Address - City:MANKATO
Mailing Address - State:MN
Mailing Address - Zip Code:56001
Mailing Address - Country:US
Mailing Address - Phone:507-389-6276
Mailing Address - Fax:
Practice Address - Street 1:21 CARKOSKI COMMONS
Practice Address - Street 2:MINNESOTA STATE UNIVERSITY, MANKATO
Practice Address - City:MANKATO
Practice Address - State:MN
Practice Address - Zip Code:56001-6030
Practice Address - Country:US
Practice Address - Phone:507-389-6276
Practice Address - Fax:507-389-5787
Is Sole Proprietor?:No
Enumeration Date:2005-10-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN27689207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN122248OtherUCARE
MN01-14-628OtherMEDICA
MN247M2HUOtherBCBS
MN122248OtherUCARE