Basic Information
| Provider Information | |||||||||
| NPI: | 1467410811 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | RANDALL | ||||||||
| FirstName: | JEFFREY | ||||||||
| MiddleName: | C | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1898 | ||||||||
| Address2: | |||||||||
| City: | LAWRENCE | ||||||||
| State: | KS | ||||||||
| PostalCode: | 660448898 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7858439125 | ||||||||
| FaxNumber: | 7858436973 | ||||||||
| Practice Location | |||||||||
| Address1: | 1112 W 6TH ST | ||||||||
| Address2: | STE 124 | ||||||||
| City: | LAWRENCE | ||||||||
| State: | KS | ||||||||
| PostalCode: | 660442215 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7858439125 | ||||||||
| FaxNumber: | 7858436973 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/03/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | X | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207X00000X | 0425975 | KS | X | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | 207XX0005X | 0425975 | KS | X | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Sports Medicine |
No ID Information.