Provider Demographics
NPI:1508693425
Name:COMBS, RANDALL EVAN
Entity type:Individual
Prefix:
First Name:RANDALL
Middle Name:EVAN
Last Name:COMBS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:918 WASHINGTON AVE APT 3
Mailing Address - Street 2:
Mailing Address - City:NEWPORT
Mailing Address - State:KY
Mailing Address - Zip Code:41071-2282
Mailing Address - Country:US
Mailing Address - Phone:303-551-5504
Mailing Address - Fax:
Practice Address - Street 1:918 WASHINGTON AVE APT 3
Practice Address - Street 2:
Practice Address - City:NEWPORT
Practice Address - State:KY
Practice Address - Zip Code:41071-2282
Practice Address - Country:US
Practice Address - Phone:303-551-5504
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-16
Last Update Date:2024-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program