Provider Demographics
NPI:1609833854
Name:FEEZELL, RANDALL (MD)
Entity Type:Individual
Prefix:DR
First Name:RANDALL
Middle Name:
Last Name:FEEZELL
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 1:5431 W PINNACLE POINTE DR STE 104
Mailing Address - Street 2:
Mailing Address - City:ROGERS
Mailing Address - State:AR
Mailing Address - Zip Code:72758-7032
Mailing Address - Country:US
Mailing Address - Phone:479-268-6404
Mailing Address - Fax:794-640-0304
Practice Address - Street 1:5431 W PINNACLE POINTE DR STE 104
Practice Address - Street 2:
Practice Address - City:ROGERS
Practice Address - State:AR
Practice Address - Zip Code:72758-7032
Practice Address - Country:US
Practice Address - Phone:479-268-6404
Practice Address - Fax:479-464-0030
Is Sole Proprietor?:No
Enumeration Date:2006-04-28
Last Update Date:2023-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARN-6349207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR105885001Medicaid
ARC68240Medicare UPIN
AR105885001Medicaid