Provider Demographics
NPI:1821144155
Name:SPERRING, RANDY WILLARD
Entity Type:Individual
Prefix:MR
First Name:RANDY
Middle Name:WILLARD
Last Name:SPERRING
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2032 NW 6TH ST
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32609-3526
Mailing Address - Country:US
Mailing Address - Phone:352-367-9920
Mailing Address - Fax:352-367-9921
Practice Address - Street 1:2032 NW 6TH ST
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32609-3526
Practice Address - Country:US
Practice Address - Phone:352-367-9920
Practice Address - Fax:352-367-9921
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-27
Last Update Date:2014-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL215332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL215OtherSTATE LISCENSE
FL9518941Medicaid
FL2220250001Medicare NSC