Provider Demographics
NPI:1801902176
Name:RANDLES, THOMAS W (DO)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:W
Last Name:RANDLES
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1606 TENNESSEE AVE
Mailing Address - Street 2:
Mailing Address - City:LYNN HAVEN
Mailing Address - State:FL
Mailing Address - Zip Code:32444-3653
Mailing Address - Country:US
Mailing Address - Phone:850-265-3606
Mailing Address - Fax:850-271-0400
Practice Address - Street 1:1606 TENNESSEE AVE
Practice Address - Street 2:
Practice Address - City:LYNN HAVEN
Practice Address - State:FL
Practice Address - Zip Code:32444-3653
Practice Address - Country:US
Practice Address - Phone:850-265-3606
Practice Address - Fax:850-271-0400
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLOS4777207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLE81523Medicare UPIN
FL82737Medicare ID - Type Unspecified