Gregory E. Randolph, PA-C
Individual provider Active NPI Physician Assistant · Gladbrook, IA
NPI 1912949124 · NPPES record last updated Jul 16, 2007
Key facts
- NPI
- 1912949124
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physician Assistant 363A00000X
- License
- 000693 (IA)
- Practice address
- 309 2ND St
Gladbrook, IA 50635 - Phone
- (641) 473-2707
- Fax
- (641) 473-2641
- NPI assigned
- Jun 12, 2006
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 000693 | IA | MD | Athletic Trainer |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 000693 | IA | Yes |
Addresses
Primary practice location
309 2ND St
Gladbrook, IA 50635
Mailing address
2101 Kimball Ave
LL14
Waterloo, IA 50702-5063
Phone (319) 272-1590
Other providers in Gladbrook, IA
All providers in Gladbrook, IA · Physician Assistant in Iowa
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 16, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.