Provider Demographics
NPI:1942296355
Name:GEHLE, RANDALL DAVID (DO)
Entity Type:Individual
Prefix:DR
First Name:RANDALL
Middle Name:DAVID
Last Name:GEHLE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 ELM STREET
Mailing Address - Street 2:PO BOX 490
Mailing Address - City:MCADENVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28101-0490
Mailing Address - Country:US
Mailing Address - Phone:704-824-5323
Mailing Address - Fax:704-824-5410
Practice Address - Street 1:105 ELM STREET
Practice Address - Street 2:
Practice Address - City:MCADENVILLE
Practice Address - State:NC
Practice Address - Zip Code:28101-0490
Practice Address - Country:US
Practice Address - Phone:704-824-5323
Practice Address - Fax:704-824-5410
Is Sole Proprietor?:No
Enumeration Date:2005-09-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC96-00920207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2400071Medicare ID - Type Unspecified
NCF99976Medicare UPIN