Provider Demographics
NPI:1215935671
Name:HALL, RANDALL WAYNE (DPM)
Entity type:Individual
Prefix:DR
First Name:RANDALL
Middle Name:WAYNE
Last Name:HALL
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:326 HIGHLAND PARK DR
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:KY
Mailing Address - Zip Code:40475-3487
Mailing Address - Country:US
Mailing Address - Phone:859-623-3550
Mailing Address - Fax:859-623-3393
Practice Address - Street 1:326 HIGHLAND PARK DR
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:KY
Practice Address - Zip Code:40475-3487
Practice Address - Country:US
Practice Address - Phone:859-623-3550
Practice Address - Fax:859-623-3393
Is Sole Proprietor?:No
Enumeration Date:2005-07-11
Last Update Date:2019-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY274213E00000X
KY244161213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY80000185Medicaid
KY000000330836OtherANTHEM
KY0915401Medicare PIN
KY000000330836OtherANTHEM
KYP00141433Medicare PIN