Provider Demographics
NPI:1538232772
Name:HUSS, RANDALL D (MD)
Entity type:Individual
Prefix:DR
First Name:RANDALL
Middle Name:D
Last Name:HUSS
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:PO BOX 2580
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65801-2580
Mailing Address - Country:US
Mailing Address - Phone:417-829-4620
Mailing Address - Fax:417-829-4316
Practice Address - Street 1:910 W 10TH ST
Practice Address - Street 2:
Practice Address - City:ROLLA
Practice Address - State:MO
Practice Address - Zip Code:65401-2904
Practice Address - Country:US
Practice Address - Phone:573-364-4226
Practice Address - Fax:573-364-5093
Is Sole Proprietor?:No
Enumeration Date:2006-11-16
Last Update Date:2008-07-17
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MOR6A01207QG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO201222510Medicaid
MOA11111Medicare UPIN
MO9195533230Medicare PIN