Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NX0100X | Occupational Health | DC5911 | TX |
NPI | 1871656900 |
---|---|
Provider Name | John T Randolph |
First Address | Pearland, TX 77584-7881 |
Second Address | Pearland, TX 77584-7881 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/12/2006 |
Last Update Date | 28/01/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
8F0551 | (02) | TX |