Provider Demographics
NPI:1891064150
Name:ROUNTREE, RANDOLPH PHILIP (MD, PSYD)
Entity Type:Individual
Prefix:DR
First Name:RANDOLPH
Middle Name:PHILIP
Last Name:ROUNTREE
Suffix:
Gender:M
Credentials:MD, PSYD
Other - Prefix:DR
Other - First Name:RANDOLPH
Other - Middle Name:PHILIP
Other - Last Name:ROUNTREE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD, PSYD
Mailing Address - Street 1:PO BOX 2005
Mailing Address - Street 2:
Mailing Address - City:WOODLAND PARK
Mailing Address - State:CO
Mailing Address - Zip Code:80866-2005
Mailing Address - Country:US
Mailing Address - Phone:719-238-9111
Mailing Address - Fax:
Practice Address - Street 1:1505 S DON ROSER DR STE A
Practice Address - Street 2:
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88011-4596
Practice Address - Country:US
Practice Address - Phone:719-238-9111
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-15
Last Update Date:2019-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO3689103TC0700X
NMC0076103TP0016X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TP0016XBehavioral Health & Social Service ProvidersPsychologistPrescribing (Medical)
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical