Provider Demographics
NPI:1821120114
Name:RANSOM, RANDY EDWIN (BS, LP, CCP)
Entity Type:Individual
Prefix:MR
First Name:RANDY
Middle Name:EDWIN
Last Name:RANSOM
Suffix:
Gender:M
Credentials:BS, LP, CCP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5204 50TH ST
Mailing Address - Street 2:APT F-205
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79414-1833
Mailing Address - Country:US
Mailing Address - Phone:806-722-0165
Mailing Address - Fax:806-722-0165
Practice Address - Street 1:3409 WORTH ST
Practice Address - Street 2:SUITE 725
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75246-2029
Practice Address - Country:US
Practice Address - Phone:214-825-2510
Practice Address - Fax:214-826-0130
Is Sole Proprietor?:No
Enumeration Date:2007-03-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPF0496246Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246Z00000XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, Other