Provider Demographics
NPI:1205020120
Name:DR. RANDY G DELCORE, M.D. P.C.
Entity Type:Organization
Organization Name:DR. RANDY G DELCORE, M.D. P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RANDY
Authorized Official - Middle Name:G
Authorized Official - Last Name:DELCORE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:435-586-1003
Mailing Address - Street 1:1335 NORTHFIELD RD STE 200
Mailing Address - Street 2:
Mailing Address - City:CEDAR CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84720-9489
Mailing Address - Country:US
Mailing Address - Phone:435-586-1003
Mailing Address - Fax:435-865-9874
Practice Address - Street 1:1335 NORTHFIELD RD STE 200
Practice Address - Street 2:
Practice Address - City:CEDAR CITY
Practice Address - State:UT
Practice Address - Zip Code:84720-9489
Practice Address - Country:US
Practice Address - Phone:435-586-1003
Practice Address - Fax:435-865-9874
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-04
Last Update Date:2007-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT95-292246-1205207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty