Provider Demographics
NPI:1588746192
Name:RANDALL FEHR MD PLLC
Entity type:Organization
Organization Name:RANDALL FEHR MD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RANDALL
Authorized Official - Middle Name:W
Authorized Official - Last Name:FEHR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:520-877-3336
Mailing Address - Street 1:10371 N ORACLE RD
Mailing Address - Street 2:SUITE 204
Mailing Address - City:ORO VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:85737-9394
Mailing Address - Country:US
Mailing Address - Phone:520-877-3336
Mailing Address - Fax:520-877-3339
Practice Address - Street 1:10371 N ORACLE RD
Practice Address - Street 2:SUITE 204
Practice Address - City:ORO VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:85737-9394
Practice Address - Country:US
Practice Address - Phone:520-877-3336
Practice Address - Fax:520-877-3339
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-20
Last Update Date:2012-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ213072084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ342105Medicaid
AZMD21307Medicare ID - Type Unspecified
B06837Medicare UPIN