Provider Demographics
NPI:1013470368
Name:OLMSTED, RANDALL ZACHARY (MD)
Entity Type:Individual
Prefix:
First Name:RANDALL
Middle Name:ZACHARY
Last Name:OLMSTED
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:UT AUSTIN DELL MEDICAL SCHOOL TRANSITIONAL PROGRAM
Mailing Address - Street 2:1400 IH-35, CEC 2.433
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78701
Mailing Address - Country:US
Mailing Address - Phone:512-324-9999
Mailing Address - Fax:
Practice Address - Street 1:UT AUSTIN DELL MEDICAL SCHOOL TRANSITIONAL PROGRAM
Practice Address - Street 2:1400 IH-35, CEC 2.433
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78701
Practice Address - Country:US
Practice Address - Phone:512-324-9999
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-12
Last Update Date:2019-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXBP10066800390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program