Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207V00000X | Obstetrician & Gynecologist | 16213 | MN |
NPI | 1013973106 |
---|---|
Provider Name | Philip S Randall |
First Address | Burnsville, MN 55337-4522 |
Second Address | Burnsville, MN 55337 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/04/2006 |
Last Update Date | 12/05/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
B58523 | (02) | MN |