Provider Demographics
NPI:1437296530
Name:TERRELL, RANDY LEE (DO)
Entity Type:Individual
Prefix:DR
First Name:RANDY
Middle Name:LEE
Last Name:TERRELL
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 848371
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02284-8371
Mailing Address - Country:US
Mailing Address - Phone:904-446-3451
Mailing Address - Fax:904-446-3013
Practice Address - Street 1:2716 W GORE BLVD
Practice Address - Street 2:SUITE C
Practice Address - City:LAWTON
Practice Address - State:OK
Practice Address - Zip Code:73505-6305
Practice Address - Country:US
Practice Address - Phone:580-357-3280
Practice Address - Fax:904-446-3013
Is Sole Proprietor?:No
Enumeration Date:2007-01-30
Last Update Date:2015-04-06
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TXH2829207Q00000X
OK5324207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXD79666Medicare UPIN