Provider Demographics
NPI:1255350757
Name:MAYDEW, RANDALL PAUL (MD)
Entity type:Individual
Prefix:
First Name:RANDALL
Middle Name:PAUL
Last Name:MAYDEW
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 1:3400 WELBORN ST
Mailing Address - Street 2:#420
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75219-5201
Mailing Address - Country:US
Mailing Address - Phone:469-964-0807
Mailing Address - Fax:214-363-7036
Practice Address - Street 1:1819 DENVER WEST DR # 26-200
Practice Address - Street 2:
Practice Address - City:GOLDEN
Practice Address - State:CO
Practice Address - Zip Code:80401-3118
Practice Address - Country:US
Practice Address - Phone:303-422-9438
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-18
Last Update Date:2008-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ0589207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX052955402Medicaid
TX33605Medicaid
NMD35818Medicare UPIN
TX00013QMedicare PIN
TXD35818Medicare UPIN
NM2135119Medicare PIN