Provider Demographics
NPI:1386061026
Name:FERRELL, RANDOLPH (MDIV)
Entity type:Individual
Prefix:MR
First Name:RANDOLPH
Middle Name:
Last Name:FERRELL
Suffix:
Gender:M
Credentials:MDIV
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5914 LONG PEAK DR
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32810-3244
Mailing Address - Country:US
Mailing Address - Phone:321-695-2975
Mailing Address - Fax:
Practice Address - Street 1:4071 L B MCLEOD RD STE A
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32811-5662
Practice Address - Country:US
Practice Address - Phone:407-745-4671
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-19
Last Update Date:2014-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management