Provider Demographics
NPI:1770205957
Name:LIBBY, RANDELL THOMAS (PHD)
Entity type:Individual
Prefix:DR
First Name:RANDELL
Middle Name:THOMAS
Last Name:LIBBY
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4616 25TH AVE NE STE 708
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98105-4183
Mailing Address - Country:US
Mailing Address - Phone:425-869-9536
Mailing Address - Fax:
Practice Address - Street 1:4933 166TH CT NE
Practice Address - Street 2:
Practice Address - City:REDMOND
Practice Address - State:WA
Practice Address - Zip Code:98052-7020
Practice Address - Country:US
Practice Address - Phone:425-885-2932
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-14
Last Update Date:2022-09-14
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes170100000XOther Service ProvidersMedical Genetics, Ph.D. Medical Genetics