Provider Demographics
NPI:1770525487
Name:OPPOLD, RANDY (PA)
Entity type:Individual
Prefix:
First Name:RANDY
Middle Name:
Last Name:OPPOLD
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 86430
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57118-6430
Mailing Address - Country:US
Mailing Address - Phone:605-322-4900
Mailing Address - Fax:605-322-4910
Practice Address - Street 1:6215 SOUTH CLIFF AVENUE
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57108-8589
Practice Address - Country:US
Practice Address - Phone:605-322-4130
Practice Address - Fax:605-322-4131
Is Sole Proprietor?:No
Enumeration Date:2006-06-10
Last Update Date:2016-05-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
SD0620363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD0620OtherPA LICENSE
SD0620OtherPA LICENSE