Provider Demographics
NPI:1912904053
Name:DRYER, RANDALL FREDERICK (MD)
Entity Type:Individual
Prefix:DR
First Name:RANDALL
Middle Name:FREDERICK
Last Name:DRYER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6818 AUSTIN CENTER BLVD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78731-3100
Mailing Address - Country:US
Mailing Address - Phone:512-795-2225
Mailing Address - Fax:512-795-0701
Practice Address - Street 1:6818 AUSTIN CENTER BLVD
Practice Address - Street 2:SUITE 200
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78731-3100
Practice Address - Country:US
Practice Address - Phone:512-795-2225
Practice Address - Fax:512-795-0701
Is Sole Proprietor?:No
Enumeration Date:2005-07-05
Last Update Date:2017-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG4110207XS0117X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the Spine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
200027195OtherMEDICARE RAILROAD
TX113904002Medicaid
200027195OtherMEDICARE RAILROAD
83V651Medicare ID - Type Unspecified