Provider Demographics
NPI:1386484947
Name:RANDDOLF PHYSICIANS PLLC
Entity type:Organization
Organization Name:RANDDOLF PHYSICIANS PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:DERRICK
Authorized Official - Middle Name:E
Authorized Official - Last Name:RANDDOLF
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:917-562-5727
Mailing Address - Street 1:24165 W INTERSTATE 10 STE 202
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78257-1160
Mailing Address - Country:US
Mailing Address - Phone:726-225-2290
Mailing Address - Fax:281-845-7063
Practice Address - Street 1:22211 IH 10 W STE 1206
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78257-1742
Practice Address - Country:US
Practice Address - Phone:917-562-5727
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-30
Last Update Date:2025-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty