Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204F00000X | Transplant Surgeon | 2010016523 | MO |
NPI | 1801817226 |
---|---|
Provider Name | Dr. Henry B Randall |
First Address | Saint Louis, MO 63150-4407 |
Second Address | Kansas City, MO 64111-5941 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/07/2006 |
Last Update Date | 28/01/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1801817226 | (05) | MO |
F68471 | (02) | MO |