Provider Demographics
NPI:1871674572
Name:MCINTYRE, RANDALL (MD)
Entity Type:Individual
Prefix:DR
First Name:RANDALL
Middle Name:
Last Name:MCINTYRE
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 1:3160 BEE CAVE RD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78746-5802
Mailing Address - Country:US
Mailing Address - Phone:512-687-3426
Mailing Address - Fax:512-730-0202
Practice Address - Street 1:3160 BEE CAVE RD
Practice Address - Street 2:SUITE 201
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78746-5802
Practice Address - Country:US
Practice Address - Phone:512-687-3426
Practice Address - Fax:512-730-0202
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH06252084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXE21211Medicare UPIN
TX8990J5Medicare ID - Type Unspecified
TX00G27JMedicare ID - Type Unspecified