Provider Demographics
NPI:1336199983
Name:GREEAR, RANDALL ALAN (DO)
Entity Type:Individual
Prefix:
First Name:RANDALL
Middle Name:ALAN
Last Name:GREEAR
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:726 MCFARLAND ST
Mailing Address - Street 2:
Mailing Address - City:MORRISTOWN
Mailing Address - State:TN
Mailing Address - Zip Code:37814-3989
Mailing Address - Country:US
Mailing Address - Phone:423-522-6146
Mailing Address - Fax:423-522-6313
Practice Address - Street 1:726 MCFARLAND ST
Practice Address - Street 2:
Practice Address - City:MORRISTOWN
Practice Address - State:TN
Practice Address - Zip Code:37814-3989
Practice Address - Country:US
Practice Address - Phone:423-522-6146
Practice Address - Fax:423-522-6313
Is Sole Proprietor?:No
Enumeration Date:2006-05-12
Last Update Date:2010-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDO0000000597207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3301168Medicaid
TND74227Medicare UPIN
TN3301168Medicare ID - Type Unspecified