Provider Demographics
NPI:1003337908
Name:RANDALL, KRISTOPHER WARD (DO, MPH)
Entity type:Individual
Prefix:
First Name:KRISTOPHER
Middle Name:WARD
Last Name:RANDALL
Suffix:
Gender:M
Credentials:DO, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:NAVAL FAMILY BRANCH HEALTH CLINIC
Mailing Address - Street 2:1 CHOME MISUMIMACHI
Mailing Address - City:IWAKUNI
Mailing Address - State:YAMAGUCHI
Mailing Address - Zip Code:96310
Mailing Address - Country:JP
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:NAVAL FAMILY BRANCH HEALTH CLINIC
Practice Address - Street 2:1 CHOME MISUMIMACHI
Practice Address - City:IWAKUNI
Practice Address - State:YAMAGUCHI
Practice Address - Zip Code:96310
Practice Address - Country:JP
Practice Address - Phone:082-794-8000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-29
Last Update Date:2024-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01022053532083A0100X, 2083A0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083A0100XAllopathic & Osteopathic PhysiciansPreventive MedicineAerospace Medicine