Provider Demographics
NPI:1598845232
Name:VEAZEY, RANDOLPH B (MD)
Entity Type:Individual
Prefix:MR
First Name:RANDOLPH
Middle Name:B
Last Name:VEAZEY
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 1:340 RICHLAND WEST CIRCLE
Mailing Address - Street 2:
Mailing Address - City:WACO
Mailing Address - State:TX
Mailing Address - Zip Code:76712
Mailing Address - Country:US
Mailing Address - Phone:254-399-9291
Mailing Address - Fax:254-399-8414
Practice Address - Street 1:340 RICHLAND WEST CIRCLE
Practice Address - Street 2:
Practice Address - City:WACO
Practice Address - State:TX
Practice Address - Zip Code:76712
Practice Address - Country:US
Practice Address - Phone:254-399-9291
Practice Address - Fax:254-399-8414
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH09022084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
87M031Medicare ID - Type UnspecifiedINDIVIDUAL
C22948Medicare UPIN
00J26AMedicare ID - Type UnspecifiedGROUP