Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080N0001X | Neonatal-Perinatal Doctor | A79066 | CA |
NPI | 1114074051 |
---|---|
Provider Name | Dr. David Alan Randolph |
First Address | Birmingham, AL 35255 |
Second Address | Birmingham, AL 35294 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/01/2007 |
Last Update Date | 11/10/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
009910610 | (05) | AL |
08909026 | MISSISSIPPI MEDICAID (01) | AL |
515-42016 | BC BS (01) | AL |
H85565 | (02) |