Provider Demographics
NPI:1558361469
Name:ALEXANDER, RANDELL (MD)
Entity Type:Individual
Prefix:
First Name:RANDELL
Middle Name:
Last Name:ALEXANDER
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 1:1650 PRUDENTIAL DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32207-8147
Mailing Address - Country:US
Mailing Address - Phone:904-633-0190
Mailing Address - Fax:904-633-0191
Practice Address - Street 1:1650 PRUDENTIAL DR
Practice Address - Street 2:SUITE 100
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32207-8147
Practice Address - Country:US
Practice Address - Phone:904-633-0190
Practice Address - Fax:904-633-0191
Is Sole Proprietor?:No
Enumeration Date:2005-07-21
Last Update Date:2007-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA045690208000000X
FLME91394208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
37BBFKXMedicare ID - Type Unspecified
A02452Medicare UPIN