Provider Demographics
NPI:1407852346
Name:BLINN, RANDALL DAVID (MD)
Entity Type:Individual
Prefix:DR
First Name:RANDALL
Middle Name:DAVID
Last Name:BLINN
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:11440 SW 88TH ST
Mailing Address - Street 2:STE 111
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33176-1024
Mailing Address - Country:US
Mailing Address - Phone:305-279-2840
Mailing Address - Fax:305-279-2644
Practice Address - Street 1:11440 SW 88TH ST
Practice Address - Street 2:STE 111
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33176-1024
Practice Address - Country:US
Practice Address - Phone:305-279-2840
Practice Address - Fax:305-279-2644
Is Sole Proprietor?:No
Enumeration Date:2005-06-24
Last Update Date:2013-11-01
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLME0063265207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL379628100Medicaid
FLG07472Medicare UPIN