Provider Demographics
NPI:1780688648
Name:VINTHER, RANDAL N (MD)
Entity Type:Individual
Prefix:DR
First Name:RANDAL
Middle Name:N
Last Name:VINTHER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:409 RUSSEL BLVD
Mailing Address - Street 2:SUITE D
Mailing Address - City:NACOGDOCHES
Mailing Address - State:TX
Mailing Address - Zip Code:75965-1248
Mailing Address - Country:US
Mailing Address - Phone:936-569-8205
Mailing Address - Fax:936-560-6962
Practice Address - Street 1:409 RUSSEL BLVD
Practice Address - Street 2:SUITE D
Practice Address - City:NACOGDOCHES
Practice Address - State:TX
Practice Address - Zip Code:75965-1248
Practice Address - Country:US
Practice Address - Phone:936-569-8205
Practice Address - Fax:936-560-6962
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXH7246207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXH7246OtherTEXAS MEDICAL LICENSE
TX00D54FOtherBLUE CROSS BLUE SHIELD TX
TXH7246OtherTEXAS MEDICAL LICENSE
TXE17857Medicare UPIN