Provider Demographics
NPI:1528658135
Name:MCDOUGAL, RANDAL ARDEST
Entity type:Individual
Prefix:MR
First Name:RANDAL
Middle Name:ARDEST
Last Name:MCDOUGAL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2046 DEAD FALL RD.
Mailing Address - Street 2:
Mailing Address - City:SMITH FIELD
Mailing Address - State:WV
Mailing Address - Zip Code:26437
Mailing Address - Country:US
Mailing Address - Phone:304-334-2636
Mailing Address - Fax:
Practice Address - Street 1:2046 DEAD FALL RD.
Practice Address - Street 2:
Practice Address - City:SMITH FIELD
Practice Address - State:WV
Practice Address - Zip Code:26437
Practice Address - Country:US
Practice Address - Phone:304-334-2636
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-19
Last Update Date:2021-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant