Provider Demographics
NPI:1467455857
Name:HIMES, RAND S (DO)
Entity Type:Individual
Prefix:
First Name:RAND
Middle Name:S
Last Name:HIMES
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:647 NORTH BROAD STREET EXT.
Mailing Address - Street 2:WOLF CREEK MEDICAL ASSOCIATES
Mailing Address - City:GROVE CITY
Mailing Address - State:PA
Mailing Address - Zip Code:16127-4604
Mailing Address - Country:US
Mailing Address - Phone:724-458-7737
Mailing Address - Fax:724-458-7388
Practice Address - Street 1:647 NORTH BROAD STREET EXT
Practice Address - Street 2:
Practice Address - City:GROVE CITY
Practice Address - State:PA
Practice Address - Zip Code:16127-4604
Practice Address - Country:US
Practice Address - Phone:724-458-7737
Practice Address - Fax:724-458-7388
Is Sole Proprietor?:No
Enumeration Date:2005-05-31
Last Update Date:2010-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS004937L207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAC33880Medicare UPIN