Provider Demographics
NPI:1962481986
Name:MCGUIRE, RANDALL JAMES (CFNP)
Entity Type:Individual
Prefix:
First Name:RANDALL
Middle Name:JAMES
Last Name:MCGUIRE
Suffix:
Gender:M
Credentials:CFNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1555
Mailing Address - Street 2:
Mailing Address - City:ROSWELL
Mailing Address - State:NM
Mailing Address - Zip Code:88202-1555
Mailing Address - Country:US
Mailing Address - Phone:575-208-0106
Mailing Address - Fax:575-208-0700
Practice Address - Street 1:1627 S UNION AVE
Practice Address - Street 2:
Practice Address - City:ROSWELL
Practice Address - State:NM
Practice Address - Zip Code:88203-2656
Practice Address - Country:US
Practice Address - Phone:575-621-2007
Practice Address - Fax:575-208-0700
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-10
Last Update Date:2019-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMR38567363L00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMNM006G23OtherBCBS
NMR6548Medicaid
NM52771555Medicaid
NMNM011928OtherBCBS
P00224839OtherRR MEDICARE
NM348722902Medicare PIN
NM344534701Medicare PIN
NMNM006G23OtherBCBS