Provider Demographics
NPI:1972594281
Name:MCCOLLOUGH, RANDY F (MD)
Entity Type:Individual
Prefix:MR
First Name:RANDY
Middle Name:F
Last Name:MCCOLLOUGH
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:7800 SHOAL CREEK BLVD
Mailing Address - Street 2:SUITE 205N
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78757-1098
Mailing Address - Country:US
Mailing Address - Phone:512-206-4341
Mailing Address - Fax:512-407-1947
Practice Address - Street 1:800 W CENTRAL TEXAS EXPY
Practice Address - Street 2:STE. 355
Practice Address - City:HARKER HEIGHTS
Practice Address - State:TX
Practice Address - Zip Code:76548-1899
Practice Address - Country:US
Practice Address - Phone:254-526-2085
Practice Address - Fax:254-526-9569
Is Sole Proprietor?:No
Enumeration Date:2005-11-04
Last Update Date:2022-01-13
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Provider Licenses
StateLicense IDTaxonomies
TXH2585207RC0000X, 207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXC19067Medicare UPIN
TXTXB102781Medicare PIN
TX8G7190Medicare PIN