Provider Demographics
NPI:1467509752
Name:RELYEA, RANDALL M (DO)
Entity Type:Individual
Prefix:DR
First Name:RANDALL
Middle Name:M
Last Name:RELYEA
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:PO BOX 873
Mailing Address - Street 2:
Mailing Address - City:PRICE
Mailing Address - State:UT
Mailing Address - Zip Code:84501-0873
Mailing Address - Country:US
Mailing Address - Phone:435-613-1238
Mailing Address - Fax:435-613-1239
Practice Address - Street 1:280 N HOSPITAL DR
Practice Address - Street 2:SUITE #3
Practice Address - City:PRICE
Practice Address - State:UT
Practice Address - Zip Code:84501-4216
Practice Address - Country:US
Practice Address - Phone:435-613-1238
Practice Address - Fax:435-613-1239
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5589865-1204207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
UTI17062Medicare UPIN