Provider Demographics
NPI:1508868654
Name:TROYER, RANDAL L (MD)
Entity Type:Individual
Prefix:DR
First Name:RANDAL
Middle Name:L
Last Name:TROYER
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 1:2035 MESQUITE AVE STE A
Mailing Address - Street 2:
Mailing Address - City:LAKE HAVASU CITY
Mailing Address - State:AZ
Mailing Address - Zip Code:86403-5894
Mailing Address - Country:US
Mailing Address - Phone:928-846-4343
Mailing Address - Fax:928-846-4353
Practice Address - Street 1:2035 MESQUITE AVE STE A
Practice Address - Street 2:
Practice Address - City:LAKE HAVASU CITY
Practice Address - State:AZ
Practice Address - Zip Code:86403-5894
Practice Address - Country:US
Practice Address - Phone:928-846-4343
Practice Address - Fax:928-846-4353
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-10
Last Update Date:2020-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ31396207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ789563Medicaid
AZ104008Medicare PIN