Provider Demographics
NPI:1881902500
Name:MCDAVID, RANDALL SCOTT (NP)
Entity type:Individual
Prefix:
First Name:RANDALL
Middle Name:SCOTT
Last Name:MCDAVID
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:RANDALL
Other - Middle Name:SCOTT
Other - Last Name:SALYER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:6260 E COLFAX AVE
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80220-1515
Mailing Address - Country:US
Mailing Address - Phone:303-962-5317
Mailing Address - Fax:720-372-7849
Practice Address - Street 1:6260 E COLFAX AVE
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80220
Practice Address - Country:US
Practice Address - Phone:303-962-5317
Practice Address - Fax:720-372-7849
Is Sole Proprietor?:No
Enumeration Date:2010-09-15
Last Update Date:2018-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0101394363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO900158746Medicaid
INM400052214Medicare PIN
INM400052213Medicare PIN
INM400052212Medicare PIN
IN201000080Medicaid
INM400052211Medicare PIN
INM400052216Medicare PIN
INM400031240Medicare PIN