Provider Demographics
NPI:1679987820
Name:PARR, RANDY
Entity Type:Individual
Prefix:
First Name:RANDY
Middle Name:
Last Name:PARR
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:856 15TH AVE
Mailing Address - Street 2:
Mailing Address - City:LONGVIEW
Mailing Address - State:WA
Mailing Address - Zip Code:98632-2321
Mailing Address - Country:US
Mailing Address - Phone:360-423-3608
Mailing Address - Fax:360-748-8672
Practice Address - Street 1:856 15TH AVE
Practice Address - Street 2:
Practice Address - City:LONGVIEW
Practice Address - State:WA
Practice Address - Zip Code:98632-2321
Practice Address - Country:US
Practice Address - Phone:360-423-3608
Practice Address - Fax:360-748-8672
Is Sole Proprietor?:No
Enumeration Date:2014-06-16
Last Update Date:2014-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAHA00000506174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist