Provider Demographics
NPI:1407814965
Name:OLDROYD, RANDALL KYLE (MD)
Entity Type:Individual
Prefix:DR
First Name:RANDALL
Middle Name:KYLE
Last Name:OLDROYD
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 1:750 WELLINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:GRAND JUNCTION
Mailing Address - State:CO
Mailing Address - Zip Code:81501-6132
Mailing Address - Country:US
Mailing Address - Phone:970-298-7500
Mailing Address - Fax:970-298-7262
Practice Address - Street 1:600 S 5TH ST
Practice Address - Street 2:
Practice Address - City:MONTROSE
Practice Address - State:CO
Practice Address - Zip Code:81401-5711
Practice Address - Country:US
Practice Address - Phone:970-240-7242
Practice Address - Fax:970-240-7793
Is Sole Proprietor?:No
Enumeration Date:2006-05-03
Last Update Date:2014-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO44421174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
COCOA106518Medicare PIN