Provider Demographics
NPI:1932169331
Name:KASTNER, RANDY RAY (MD)
Entity Type:Individual
Prefix:DR
First Name:RANDY
Middle Name:RAY
Last Name:KASTNER
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:PO BOX 844658
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75284-4658
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6684 W ADAMS AVE
Practice Address - Street 2:
Practice Address - City:TEMPLE
Practice Address - State:TX
Practice Address - Zip Code:76502-5632
Practice Address - Country:US
Practice Address - Phone:254-899-4200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-28
Last Update Date:2022-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ6518208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX85Z660OtherBLUE SHIELD
TX370017505OtherRR/MEDICARE
TX85Z660OtherBLUE SHIELD
TX1048787-01OtherCSHCN
TX1048787-02Medicaid
TX85Z660OtherBLUE SHIELD