Randal Boyd Gibb, MD

Primary specialty

Otolaryngology PhysicianTaxonomy code 207Y00000X

License

1650121205 Issued in UT

Practice address

820 S Woodland Hills Dr
Woodland Hills, UT 84653-2030

Phone

(801) 372-8314

NPI assigned

Sep 2, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 7

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

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

{
    "created_epoch": "1157155200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1594166400000",
    "number": "1679675383",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1055 N 500 W",
            "address_2": "CREDENTIALING DEPARTMENT",
            "city": "PROVO",
            "state": "UT",
            "postal_code": "846043305",
            "telephone_number": "801-354-8225",
            "fax_number": "801-418-0941"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "820 S WOODLAND HILLS DR",
            "city": "WOODLAND HILLS",
            "state": "UT",
            "postal_code": "846532030",
            "telephone_number": "801-372-8314"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "39 Professional Way",
            "address_2": "Suite 1",
            "address_purpose": "LOCATION",
            "city": "Payson",
            "state": "UT",
            "postal_code": "846511675",
            "country_code": "US",
            "telephone_number": "801-465-4805",
            "fax_number": "801-465-4354",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "GIBB",
        "first_name": "RANDAL",
        "middle_name": "BOYD",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-09-02",
        "last_updated": "2020-07-08",
        "certification_date": "2020-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Y00000X",
            "taxonomy_group": "",
            "desc": "Otolaryngology",
            "state": "UT",
            "license": "1650121205",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "EMIA",
            "identifier": "870281028RG2",
            "state": "UT"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITED HEALTHCARE",
            "identifier": "10-00362",
            "state": "UT"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "IHC",
            "identifier": "107006654103",
            "state": "UT"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ALTIUS",
            "identifier": "233116",
            "state": "UT"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DMBA",
            "identifier": "36245",
            "state": "UT"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PEHP",
            "identifier": "81445",
            "state": "UT"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PALMETTO",
            "identifier": "P00215615",
            "state": "UT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Craig Baker, MFT
• Amy E Bartholomew, ATC
• Daniel S. Mehr, M.D., P.C.
• Kaycie Johanna Davis, APRN, PMHNP-BC
• Kaila Fredrick
• Independent Histology Service LLC
• Scott Innes
• Bill Clifford Marshall, PH.D.
• Debra Theobald McClendon, PH.D.
• Madyson Marie Meeks

• Otolaryngology Physician in Woodland Hills, UT
• Providers in Woodland Hills, UT by specialty
• Otolaryngology Physician in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2020; 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.