Provider Demographics
NPI:1588643167
Name:JAMES, RANDALL LEE (OTR)
Entity Type:Individual
Prefix:
First Name:RANDALL
Middle Name:LEE
Last Name:JAMES
Suffix:
Gender:M
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PSC 827, BOX 20
Mailing Address - Street 2:
Mailing Address - City:FPO
Mailing Address - State:ITALY
Mailing Address - Zip Code:AE
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:PSC 827, BOX 20
Practice Address - Street 2:
Practice Address - City:FPO
Practice Address - State:ITALY
Practice Address - Zip Code:AE
Practice Address - Country:US
Practice Address - Phone:081-811-4676
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1007421710I1003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1003XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Medical Technicians