Provider Demographics
NPI:1467413120
Name:RIEGLER, RANDALL ALBERT (MD)
Entity Type:Individual
Prefix:
First Name:RANDALL
Middle Name:ALBERT
Last Name:RIEGLER
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 1:8614 BAYMEADOWS WAY
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32256-8236
Mailing Address - Country:US
Mailing Address - Phone:904-448-4640
Mailing Address - Fax:904-448-7120
Practice Address - Street 1:8614 BAYMEADOWS WAY
Practice Address - Street 2:SUITE 101
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32256-8236
Practice Address - Country:US
Practice Address - Phone:904-448-4640
Practice Address - Fax:904-448-7120
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-31
Last Update Date:2012-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0050465207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL046935100Medicaid
FLD50773Medicare UPIN
FL046935100Medicaid