Provider Demographics
NPI:1588658546
Name:SECHREST, RANDALE CRAIG (MD)
Entity Type:Individual
Prefix:DR
First Name:RANDALE
Middle Name:CRAIG
Last Name:SECHREST
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:228 W MAIN ST
Mailing Address - Street 2:SUITE D
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59802-4345
Mailing Address - Country:US
Mailing Address - Phone:406-721-3072
Mailing Address - Fax:406-721-2619
Practice Address - Street 1:228 W MAIN ST
Practice Address - Street 2:SUITE D
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59802-4345
Practice Address - Country:US
Practice Address - Phone:406-721-3072
Practice Address - Fax:406-721-2619
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MT6144207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0063401Medicaid
MT94230OtherBLUE CROSS/BLUE SHIELD
MTC64256Medicare UPIN