Provider Demographics
NPI:1801845920
Name:MIDDLETON, RANDLE THOMAS (MD)
Entity Type:Individual
Prefix:MR
First Name:RANDLE
Middle Name:THOMAS
Last Name:MIDDLETON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2089 CECIL ASHBURN DRIVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35802
Mailing Address - Country:US
Mailing Address - Phone:256-882-7351
Mailing Address - Fax:256-489-2322
Practice Address - Street 1:2089 CECIL ASHBURN DRIVE
Practice Address - Street 2:SUITE 101
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35802
Practice Address - Country:US
Practice Address - Phone:256-882-7351
Practice Address - Fax:256-489-2322
Is Sole Proprietor?:No
Enumeration Date:2006-05-08
Last Update Date:2013-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL18862207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
51038324OtherBCBS
AL000038324Medicare Oscar/Certification
F60057Medicare UPIN
000038324Medicare ID - Type Unspecified