Randolph Barret Mahoney, PA-C, PHD

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

PA 9101713 Issued in FL

Practice address

1541 Riverside Ave
Jacksonville, FL 32204-4124

Phone

(904) 354-4488

Fax

(904) 634-8912

NPI assigned

Aug 18, 2005

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant, Doctor of Philosophy

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• North Florida Dermatology Associates, PA

  • Specialist
  • Jacksonville, FL
  • NPI 1992851620
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1124323200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1194998400000",
    "number": "1669464236",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 42",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322100042",
            "telephone_number": "904-354-4488",
            "fax_number": "904-634-8912"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1541 RIVERSIDE AVE",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322044124",
            "telephone_number": "904-354-4488",
            "fax_number": "904-634-8912"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MAHONEY",
        "first_name": "RANDOLPH",
        "middle_name": "BARRET",
        "name_prefix": "Dr.",
        "credential": "PA-C, PHD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-08-18",
        "last_updated": "2007-11-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "FL",
            "license": "PA 9101713",
            "primary": true
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "FL",
            "license": "PA 9101713",
            "primary": false
        },
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "FL",
            "license": "PA 9101713",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Omar Mahmoud, M.D.
• Saniyyah Itani Mahmoudi, ARNP
• Abusad Mahmud, DMD
• Clerissa C Mahon, APRN
• Katie S Mahon, PH.D.
• Sherry Mahoney, RDN
• Ranya Mahrous
• Eileen Mahusay, CRNA
• Clarence Nguyen Mai, MD
• Huan Mai

• All providers in Jacksonville, FL
• Physician Assistant in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 14, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.