Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 102L00000X | Psychologist | 24796 | TX |
Y | 103T00000X | Psychologist | 24796 | TX |
NPI | 1013060946 |
---|---|
Provider Name | Dr. Patrick David Randolph |
First Address | Lubbock, TX 79424-1646 |
Second Address | Lubbock, TX 79424-1646 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/01/2007 |
Last Update Date | 13/10/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
099265302 | (05) | TX |