Provider Demographics
NPI:1245793728
Name:RANDALL, GRANT JEFFREY (MD)
Entity Type:Individual
Prefix:
First Name:GRANT
Middle Name:JEFFREY
Last Name:RANDALL
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:UNIVERSITY OF FLORIDA COLLEGE OF MEDICINE
Mailing Address - Street 2:1600 SW ARCHER ROAD, ROOM 4102
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32610-0277
Mailing Address - Country:US
Mailing Address - Phone:352-265-0239
Mailing Address - Fax:
Practice Address - Street 1:UNIVERSITY OF FLORIDA COLLEGE OF MEDICINE
Practice Address - Street 2:1600 SW ARCHER ROAD, ROOM 4102
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32610-0277
Practice Address - Country:US
Practice Address - Phone:352-265-0239
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-10
Last Update Date:2019-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program