Provider Demographics
NPI:1376658781
Name:HORRAS, RANDY J (MD)
Entity Type:Individual
Prefix:
First Name:RANDY
Middle Name:J
Last Name:HORRAS
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 1:7600 WOLF RIVER BLVD STE 200
Mailing Address - Street 2:
Mailing Address - City:GERMANTOWN
Mailing Address - State:TN
Mailing Address - Zip Code:38138-1788
Mailing Address - Country:US
Mailing Address - Phone:901-747-1000
Mailing Address - Fax:901-747-1001
Practice Address - Street 1:6019 WALNUT GROVE
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38120
Practice Address - Country:US
Practice Address - Phone:901-383-8860
Practice Address - Fax:901-383-1194
Is Sole Proprietor?:No
Enumeration Date:2006-08-19
Last Update Date:2022-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN378602085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR154102001Medicaid
TN3328225Medicaid
MS03732075Medicaid
MO207364209Medicaid
TN4104623OtherBCBS
AR5M839OtherBCBS
MS03732075Medicaid
TN3328225Medicare ID - Type Unspecified
AR154102001Medicaid
104641Medicare UPIN