Provider Demographics
NPI:1154373892
Name:MINOR, RANDALL M
Entity type:Individual
Prefix:DR
First Name:RANDALL
Middle Name:M
Last Name:MINOR
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1149
Mailing Address - Street 2:
Mailing Address - City:BELLS
Mailing Address - State:TN
Mailing Address - Zip Code:38006-1149
Mailing Address - Country:US
Mailing Address - Phone:731-512-0494
Mailing Address - Fax:731-512-0497
Practice Address - Street 1:301 TYSON AVE
Practice Address - Street 2:HENRY COUNTY MEDICAL CENTER EMERGENCY DE
Practice Address - City:PARIS
Practice Address - State:TN
Practice Address - Zip Code:38242-4544
Practice Address - Country:US
Practice Address - Phone:731-644-8445
Practice Address - Fax:731-644-8446
Is Sole Proprietor?:No
Enumeration Date:2006-05-17
Last Update Date:2015-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD025183207PE0004X
TN632449207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical Services
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3119997OtherBCBS
TN3097925Medicaid
TN3097925Medicare ID - Type Unspecified
TN3119997OtherBCBS