Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VX0201X | Gynecologic Oncologist | C6621 | AR |
NPI | 1235189069 |
---|---|
Provider Name | Randall D Hightower |
First Address | Fayetteville, AR 72703-4424 |
Second Address | Fayetteville, AR 72703-4424 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/05/2006 |
Last Update Date | 12/02/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
143972001 | (05) | AR |
5K688 | BLUE (01) | AR |
G63651 | (02) |