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1841233186
RANDALL R SOUTHARDS
GREEN BAY, WI
NPI
1841233186
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
No
Primary Taxonomy
363A00000X Physician Assistant
(Licence: WI 1402)
Enumeration Date
2006-06-14
Last Update Date
2024-02-16
Business Address
RANDALL R SOUTHARDS PA
2845 GREENBRIER RD STE 320
GREEN BAY, WI 54311-6519
Phone number: 920-288-8320
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Mailing Address
RANDALL R SOUTHARDS PA
2845 GREENBRIER RD STE 320 PO BOX 8900
GREEN BAY, WI 54308-8900
Phone number: 920-288-8320
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