Provider Demographics
NPI:1477523975
Name:SHUCK, RANDY A (DO)
Entity Type:Individual
Prefix:
First Name:RANDY
Middle Name:A
Last Name:SHUCK
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 1:6800 GULFPORT BLVD S STE 101
Mailing Address - Street 2:
Mailing Address - City:SOUTH PASADENA
Mailing Address - State:FL
Mailing Address - Zip Code:33707-2193
Mailing Address - Country:US
Mailing Address - Phone:727-328-3324
Mailing Address - Fax:877-592-0792
Practice Address - Street 1:6800 GULFPORT BLVD S STE 101
Practice Address - Street 2:
Practice Address - City:SOUTH PASADENA
Practice Address - State:FL
Practice Address - Zip Code:33707-2193
Practice Address - Country:US
Practice Address - Phone:727-328-3324
Practice Address - Fax:877-592-0792
Is Sole Proprietor?:No
Enumeration Date:2006-01-25
Last Update Date:2022-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS7079207Q00000X, 207Q00000X
MT77691208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist