Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208G00000X | Cardiothoracic Vascular Surgeon | 14020 | ND |
NPI | 1073506648 |
---|---|
Provider Name | Randy K Metcalf |
First Address | Pensacola, FL 32513-2699 |
Second Address | Fargo, ND 58103-6132 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/08/2005 |
Last Update Date | 17/03/2018 |