Provider Demographics
NPI:1235189069
Name:HIGHTOWER, RANDALL D (MD)
Entity Type:Individual
Prefix:
First Name:RANDALL
Middle Name:D
Last Name:HIGHTOWER
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 1:3215 N NORTHHILLS BLVD
Mailing Address - Street 2:SUITE B
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72703-4424
Mailing Address - Country:US
Mailing Address - Phone:479-463-5500
Mailing Address - Fax:479-463-5542
Practice Address - Street 1:3215 N NORTHHILLS BLVD
Practice Address - Street 2:SUITE B
Practice Address - City:FAYETTEVILLE
Practice Address - State:AR
Practice Address - Zip Code:72703-4424
Practice Address - Country:US
Practice Address - Phone:479-463-5500
Practice Address - Fax:479-463-5542
Is Sole Proprietor?:No
Enumeration Date:2006-05-11
Last Update Date:2009-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARC6621207VX0201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VX0201XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologic Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5K688OtherBLUE
AR143972001Medicaid
AR143972001Medicaid
AR5K688OtherBLUE