Provider Demographics
NPI:1619906856
Name:RICKARD, RANDALL C (MD)
Entity Type:Individual
Prefix:DR
First Name:RANDALL
Middle Name:C
Last Name:RICKARD
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 1:515 E BELL ST
Mailing Address - Street 2:
Mailing Address - City:MURFREESBORO
Mailing Address - State:TN
Mailing Address - Zip Code:37130-3001
Mailing Address - Country:US
Mailing Address - Phone:615-890-9191
Mailing Address - Fax:615-890-2200
Practice Address - Street 1:515 E BELL ST
Practice Address - Street 2:
Practice Address - City:MURFREESBORO
Practice Address - State:TN
Practice Address - Zip Code:37130-3001
Practice Address - Country:US
Practice Address - Phone:615-890-9191
Practice Address - Fax:615-890-2200
Is Sole Proprietor?:No
Enumeration Date:2006-07-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN13277207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3059248OtherBLUE CROSS PROVIDER #
TN13277OtherLICENSE #
TN3188546Medicare ID - Type Unspecified
TN13277OtherLICENSE #