Provider Demographics
NPI:1710901442
Name:RANDOLPH, STEVEN HRAOLD (MD)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:HRAOLD
Last Name:RANDOLPH
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 1:5757 WESTHEIMER RD
Mailing Address - Street 2:SUITE 3-204
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77057-5749
Mailing Address - Country:US
Mailing Address - Phone:832-748-8198
Mailing Address - Fax:
Practice Address - Street 1:5757 WESTHEIMER RD
Practice Address - Street 2:SUITE 3-204
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77057-5749
Practice Address - Country:US
Practice Address - Phone:832-748-8198
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2014-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH2959207P00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXC20849Medicare UPIN