Provider Demographics
NPI:1528004850
Name:JUEL, RANDOLPH WADE (MD)
Entity Type:Individual
Prefix:
First Name:RANDOLPH
Middle Name:WADE
Last Name:JUEL
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 1:505 S 336TH ST
Mailing Address - Street 2:SUITE 600
Mailing Address - City:FEDERAL WAY
Mailing Address - State:WA
Mailing Address - Zip Code:98003-6328
Mailing Address - Country:US
Mailing Address - Phone:253-838-6180
Mailing Address - Fax:253-838-6418
Practice Address - Street 1:1211 24TH ST
Practice Address - Street 2:
Practice Address - City:ANACORTES
Practice Address - State:WA
Practice Address - Zip Code:98221-2557
Practice Address - Country:US
Practice Address - Phone:360-299-1311
Practice Address - Fax:360-299-1312
Is Sole Proprietor?:No
Enumeration Date:2006-06-22
Last Update Date:2008-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00013212207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1190JUOtherBSWA
WA1211JUOtherBSWA
WA8171290Medicaid
WA0229020OtherLIWA
WA8259301Medicaid
WA8171290Medicaid
WA0229020OtherLIWA
WAGAB20297Medicare PIN