Provider Demographics
NPI:1326195173
Name:NORD, RANDALL LEE (PA)
Entity type:Individual
Prefix:
First Name:RANDALL
Middle Name:LEE
Last Name:NORD
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1004 1ST ST N STE 390
Mailing Address - Street 2:
Mailing Address - City:ALABASTER
Mailing Address - State:AL
Mailing Address - Zip Code:35007-8616
Mailing Address - Country:US
Mailing Address - Phone:205-620-7523
Mailing Address - Fax:
Practice Address - Street 1:1004 1ST ST N STE 390
Practice Address - Street 2:
Practice Address - City:ALABASTER
Practice Address - State:AL
Practice Address - Zip Code:35007-8616
Practice Address - Country:US
Practice Address - Phone:205-620-7523
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-04
Last Update Date:2024-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC5387363AS0400X
MO2023025752363AS0400X
ALPA.763363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL133039Medicaid
AL051120557OtherBCBS
AL051120559OtherBCBS
AL133030Medicaid
AL133034Medicaid
NC970024545OtherRAILROAD MEDICARE
AL051120556OtherBCBS
MS06021281Medicaid
NC7901940Medicaid
ALS17209OtherVIVA
NC2753034AMedicare ID - Type Unspecified
AL051120556OtherBCBS
AL102I971548Medicare PIN