Provider Demographics
NPI:1427091339
Name:DAVIS, RANDALL THOMAS (MD)
Entity type:Individual
Prefix:DR
First Name:RANDALL
Middle Name:THOMAS
Last Name:DAVIS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 911230
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75391-1230
Mailing Address - Country:US
Mailing Address - Phone:972-997-8000
Mailing Address - Fax:972-437-9605
Practice Address - Street 1:1609 HOSPITAL PKWY
Practice Address - Street 2:
Practice Address - City:BEDFORD
Practice Address - State:TX
Practice Address - Zip Code:76022-6920
Practice Address - Country:US
Practice Address - Phone:817-359-9096
Practice Address - Fax:817-354-8969
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2021-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ0469207RX0202X, 207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
No207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX135865703Medicaid
TX135865705Medicaid
TX135865709Medicaid
TX135865701Medicaid
TX135865704Medicaid
TX8R1422OtherBLUE CROSS OF TEXAS
TX135865702Medicaid
TX135865706Medicaid