Provider Demographics
NPI:1275528432
Name:RANDALL, JAMES (MD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:
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 1:1221 N 26TH ST
Mailing Address - Street 2:
Mailing Address - City:BILLINGS
Mailing Address - State:MT
Mailing Address - Zip Code:59101-0232
Mailing Address - Country:US
Mailing Address - Phone:406-252-5681
Mailing Address - Fax:406-252-5025
Practice Address - Street 1:1221 N 26TH ST
Practice Address - Street 2:
Practice Address - City:BILLINGS
Practice Address - State:MT
Practice Address - Zip Code:59101-0232
Practice Address - Country:US
Practice Address - Phone:406-252-5681
Practice Address - Fax:406-252-5025
Is Sole Proprietor?:No
Enumeration Date:2005-09-14
Last Update Date:2010-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT5055207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT073957Medicaid
ID807213000Medicaid
MT073957Medicaid
ID807213000Medicaid