Provider Demographics
NPI:1932198611
Name:RANDELL, DAVID JOSEPH (DO)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:JOSEPH
Last Name:RANDELL
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35 WINDMILL CIR
Mailing Address - Street 2:
Mailing Address - City:ABILENE
Mailing Address - State:TX
Mailing Address - Zip Code:79606-5234
Mailing Address - Country:US
Mailing Address - Phone:325-698-4221
Mailing Address - Fax:325-698-6951
Practice Address - Street 1:6250 REGIONAL PLZ
Practice Address - Street 2:SUITE 1010
Practice Address - City:ABILENE
Practice Address - State:TX
Practice Address - Zip Code:79606-5262
Practice Address - Country:US
Practice Address - Phone:325-428-5500
Practice Address - Fax:325-428-5519
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-17
Last Update Date:2013-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH5795207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX133854306Medicaid
E43918Medicare UPIN
TX133854306Medicaid