Provider Demographics
NPI:1760541171
Name:HAMRIC, RANDAL L (MD)
Entity Type:Individual
Prefix:DR
First Name:RANDAL
Middle Name:L
Last Name:HAMRIC
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 1:1850 W REPUBLIC RD
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65807-5730
Mailing Address - Country:US
Mailing Address - Phone:417-891-4800
Mailing Address - Fax:417-891-4913
Practice Address - Street 1:1850 W REPUBLIC RD
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65807-5730
Practice Address - Country:US
Practice Address - Phone:417-891-4800
Practice Address - Fax:417-891-4913
Is Sole Proprietor?:No
Enumeration Date:2006-12-08
Last Update Date:2022-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC50423207Q00000X
MOR4E85207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOP00331490Medicaid
D16940Medicare UPIN