Basic Information
| Provider Information | |||||||||
| NPI: | 1114074051 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | RANDOLPH | ||||||||
| FirstName: | DAVID | ||||||||
| MiddleName: | ALAN | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D., PH.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 55823 | ||||||||
| Address2: | |||||||||
| City: | BIRMINGHAM | ||||||||
| State: | AL | ||||||||
| PostalCode: | 35255 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2059962244 | ||||||||
| FaxNumber: | 2059962254 | ||||||||
| Practice Location | |||||||||
| Address1: | 619 SOUTH 19TH STREET | ||||||||
| Address2: | NHB 525 | ||||||||
| City: | BIRMINGHAM | ||||||||
| State: | AL | ||||||||
| PostalCode: | 35294 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2059344680 | ||||||||
| FaxNumber: | 2059343100 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/04/2007 | ||||||||
| LastUpdateDate: | 10/11/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2080N0001X | A79066 | CA | Y | Allopathic & Osteopathic Physicians | Pediatrics | Neonatal-Perinatal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 009910610 | 05 | AL | MEDICAID | 08909026 | 01 | AL | MISSISSIPPI MEDICAID | OTHER | 515-42016 | 01 | AL | BC BS | OTHER |