Provider Demographics
NPI:1952386401
Name:HOWARD, RANDY (MD)
Entity Type:Individual
Prefix:MR
First Name:RANDY
Middle Name:
Last Name:HOWARD
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 1:107 GLEN OAK BLVD
Mailing Address - Street 2:SUITE 202
Mailing Address - City:HENDERSONVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37075
Mailing Address - Country:US
Mailing Address - Phone:615-826-0710
Mailing Address - Fax:615-826-0910
Practice Address - Street 1:107 GLEN OAK BLVD
Practice Address - Street 2:SUITE 202
Practice Address - City:HENDERSONVILLE
Practice Address - State:TN
Practice Address - Zip Code:37075
Practice Address - Country:US
Practice Address - Phone:615-826-0710
Practice Address - Fax:615-826-0910
Is Sole Proprietor?:No
Enumeration Date:2005-12-07
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN39358207RG0100X
TNM0000039358207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN9398195OtherPHCS PROVIDER NUMBER
TN3983866OtherAETNA PROVIDER NUMBER
TN6591329OtherCIGNA PROVIDER NUMBER
TNH90812OtherHEALTHSPRING PROVIDER NUM
TN4109554OtherBCBS PROVIDER NUMBER
TN11491546OtherCAQH PROVIDER NUMBER
TN3331737Medicaid
TNM000039358OtherSTATE LICENSE NUMBER
TNM000039358OtherSTATE LICENSE NUMBER
TNM000039358OtherSTATE LICENSE NUMBER
TN9398195OtherPHCS PROVIDER NUMBER