Provider Demographics
NPI: | 1982609954 |
---|---|
Name: | RANDALL, DAVID CROW (MD) |
Entity type: | Individual |
Prefix: | DR |
First Name: | DAVID |
Middle Name: | CROW |
Last Name: | RANDALL |
Suffix: | |
Gender: | |
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: | 7200 CAMBRIDGE ST FL 10 |
Mailing Address - Street 2: | |
Mailing Address - City: | HOUSTON |
Mailing Address - State: | TX |
Mailing Address - Zip Code: | 77030-4202 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 713-986-6016 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 4500 E SAM HOUSTON PKWY S |
Practice Address - Street 2: | |
Practice Address - City: | PASADENA |
Practice Address - State: | TX |
Practice Address - Zip Code: | 77505-3959 |
Practice Address - Country: | US |
Practice Address - Phone: | 713-378-8230 |
Practice Address - Fax: | |
Is Sole Proprietor?: | No |
Enumeration Date: | 2005-06-16 |
Last Update Date: | 2025-04-14 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
TX | J2269 | 174400000X, 207X00000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 207X00000X | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | |
No | 174400000X | Other Service Providers | Specialist |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
200038322 | Other | MEDICARE RAILROAD | |
TX | 88771S | Other | BLUE CROSS |
TX | 124899902 | Medicaid | |
TX | 8731K0 | Medicare PIN | |
200038322 | Other | MEDICARE RAILROAD |