Provider Demographics
NPI:1891787933
Name:HOWERTON, RANDALL D (MD)
Entity Type:Individual
Prefix:
First Name:RANDALL
Middle Name:D
Last Name:HOWERTON
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 1:4309 W 27TH PL
Mailing Address - Street 2:SUITE 302
Mailing Address - City:KENNEWICK
Mailing Address - State:WA
Mailing Address - Zip Code:99338-2909
Mailing Address - Country:US
Mailing Address - Phone:509-491-3381
Mailing Address - Fax:509-491-3384
Practice Address - Street 1:4309 W 27TH PL
Practice Address - Street 2:SUITE 302
Practice Address - City:KENNEWICK
Practice Address - State:WA
Practice Address - Zip Code:99338-2909
Practice Address - Country:US
Practice Address - Phone:509-491-3381
Practice Address - Fax:509-491-3384
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-16
Last Update Date:2021-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00047434207V00000X
TXJ3498207V00000X
WAMD0047434207QA0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction Medicine
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX132708207Medicaid
TX132708207Medicaid
TX132708207Medicaid