Provider Demographics
NPI:1588856728
Name:DONALD A RANDOLPH, JR., MD, PA
Entity Type:Organization
Organization Name:DONALD A RANDOLPH, JR., MD, PA
Other - Org Name:DONALD A. RANDOLPH, JR., M.D., P.A.
Other - Org Type:Other Name
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:A
Authorized Official - Last Name:RANDOLPH
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:214-824-7744
Mailing Address - Street 1:1015 N CARROLL AVE
Mailing Address - Street 2:#2000
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75204-6604
Mailing Address - Country:US
Mailing Address - Phone:214-824-7744
Mailing Address - Fax:214-824-7755
Practice Address - Street 1:1015 N CARROLL AVE
Practice Address - Street 2:#2000
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75204-6604
Practice Address - Country:US
Practice Address - Phone:214-824-7744
Practice Address - Fax:214-824-7755
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-13
Last Update Date:2008-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM1307207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00Y207Medicare PIN