NPI | 1104014463 |
---|---|
Doing Business As | DAVID J. RANDELL, D. O., PA |
Entity Type | Organization |
Authorized Contact | DAVID JOSEPH RANDELL Owner 325-698-4221 |
Organization Subpart ? | No |
Primary Taxonomy | 302F00000X Exclusive Provider Organization (Licence: TX H5795) |
Enumeration Date | 2007-10-11 |
Last Update Date | 2007-10-11 |