Provider Demographics
NPI:1699754283
Name:RANDOLPH, JAMES G (MD)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:G
Last Name:RANDOLPH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 463
Mailing Address - Street 2:
Mailing Address - City:WORLAND
Mailing Address - State:WY
Mailing Address - Zip Code:82401-0463
Mailing Address - Country:US
Mailing Address - Phone:307-347-8262
Mailing Address - Fax:307-347-8265
Practice Address - Street 1:151 S 6THST
Practice Address - Street 2:
Practice Address - City:WORLAND
Practice Address - State:WY
Practice Address - Zip Code:82401-3339
Practice Address - Country:US
Practice Address - Phone:307-347-8262
Practice Address - Fax:307-347-8265
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-11
Last Update Date:2010-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY5211A207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
200016320OtherRAILROAD MEDICARE
WY102379900Medicaid
WY308041OtherBLUE CROSS BLUE SHIELD
WYW308041Medicare PIN
WY308041OtherBLUE CROSS BLUE SHIELD