Basic Information
| Provider Information | |||||||||
| NPI: | 1124347091 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DANIEL | ||||||||
| FirstName: | RANDY | ||||||||
| MiddleName: | A | ||||||||
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| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5100 W BROAD STREET | ||||||||
| Address2: | OUCOM/DOCTORS HOSPITAL - EMERGENCY MEDICINE | ||||||||
| City: | COLUMBUS | ||||||||
| State: | OH | ||||||||
| PostalCode: | 432281607 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6145442780 | ||||||||
| FaxNumber: | 6145441727 | ||||||||
| Practice Location | |||||||||
| Address1: | 5100 W BROAD STREET | ||||||||
| Address2: | OUCOM/DOCTORS HOSPITAL - EMERGENCY MEDICINE | ||||||||
| City: | COLUMBUS | ||||||||
| State: | OH | ||||||||
| PostalCode: | 432281607 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6145442780 | ||||||||
| FaxNumber: | 6145441727 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/18/2010 | ||||||||
| LastUpdateDate: | 11/10/2015 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | 62557-21 | WI | Y | Allopathic & Osteopathic Physicians | Emergency Medicine |
No ID Information.