Active NPI
Randal Carl Anderson, M.D.
- Diagnostic Radiology Physician
- Shreveport, LA
National Provider Identifier
1851342182
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Diagnostic Radiology Physician
- License
- M-9167
- Practice address
- 510 E Stoner Ave
Shreveport, LA 71101-4243 - Phone
- (318) 990-5322
- NPI assigned
- May 12, 2006
- Last updated
- Mar 1, 2024
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Diagnostic Radiology Physician | 2085R0202X | M-9167 | ID | Primary |
Addresses
Primary practice location
510 E Stoner Ave
Shreveport, LA 71101-4243
Mailing address
1218 Gallen Rd
Santa Clara, UT 84765-1249
Phone (319) 440-9737
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 165862001 | Medicaid | AR | |
| P00428982 | Other | AR | RAILROAD MEDICARE |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| M-9167 | ID | MD | Diagnostic Radiology Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1147392000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1709251200000",
"number": "1851342182",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1218 GALLEN RD",
"city": "SANTA CLARA",
"state": "UT",
"postal_code": "847651249",
"telephone_number": "319-440-9737"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "510 E STONER AVE",
"city": "SHREVEPORT",
"state": "LA",
"postal_code": "711014243",
"telephone_number": "318-990-5322"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ANDERSON",
"first_name": "RANDAL",
"middle_name": "CARL",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-05-12",
"last_updated": "2024-03-01",
"certification_date": "2024-03-01",
"status": "A"
},
"taxonomies": [
{
"code": "2085R0202X",
"taxonomy_group": "",
"desc": "Radiology, Diagnostic Radiology",
"state": "ID",
"license": "M-9167",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "165862001",
"state": "AR"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RAILROAD MEDICARE",
"identifier": "P00428982",
"state": "AR"
}
],
"endpoints": [],
"other_names": []
}Other providers in Shreveport, LA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 1, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.