Provider Demographics
NPI:1134221542
Name:RANDALL, RODNEY RICHARD (MD)
Entity type:Individual
Prefix:DR
First Name:RODNEY
Middle Name:RICHARD
Last Name:RANDALL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:RODNEY
Other - Middle Name:RICHARD
Other - Last Name:RANDALL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:2727 W DR MARTIN LUTHER KING JR BLVD
Mailing Address - Street 2:SUITE 418
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33607-6383
Mailing Address - Country:US
Mailing Address - Phone:813-875-9900
Mailing Address - Fax:813-873-8880
Practice Address - Street 1:2727 W DR MARTIN LUTHER KING JR BLVD
Practice Address - Street 2:SUITE 418
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33607-6383
Practice Address - Country:US
Practice Address - Phone:813-875-9900
Practice Address - Fax:813-873-8880
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-05
Last Update Date:2010-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME66099207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease