Provider Demographics
NPI:1972685212
Name:PEOPLES, RANDAL RAYMOND (MD)
Entity Type:Individual
Prefix:
First Name:RANDAL
Middle Name:RAYMOND
Last Name:PEOPLES
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 1:2865 SIENA HEIGHTS DR STE 131
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89052-4168
Mailing Address - Country:US
Mailing Address - Phone:702-616-6580
Mailing Address - Fax:
Practice Address - Street 1:2865 SIENA HEIGHTS DR STE 131
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89052-4168
Practice Address - Country:US
Practice Address - Phone:702-616-6580
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-19
Last Update Date:2017-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG75531207T00000X
NV6355207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV002019177Medicaid
F09601Medicare UPIN
NV101494Medicare ID - Type Unspecified