Provider Demographics
NPI:1962761551
Name:FEATHER, RANDALL RAY (MD)
Entity type:Individual
Prefix:
First Name:RANDALL
Middle Name:RAY
Last Name:FEATHER
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 1:3895 GRAHAMWOOD CV
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38122-3839
Mailing Address - Country:US
Mailing Address - Phone:618-731-1215
Mailing Address - Fax:
Practice Address - Street 1:3895 GRAHAMWOOD CV
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38122-3839
Practice Address - Country:US
Practice Address - Phone:618-731-1215
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-16
Last Update Date:2016-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036139323207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine