Provider Demographics
NPI:1538264361
Name:DICK, RANDALL MERLE (MD PA)
Entity type:Individual
Prefix:DR
First Name:RANDALL
Middle Name:MERLE
Last Name:DICK
Suffix:
Gender:M
Credentials:MD PA
Other - Prefix:DR
Other - First Name:RANDALL
Other - Middle Name:M
Other - Last Name:DICK
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD PA
Mailing Address - Street 1:PO BOX 848775
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02284-8775
Mailing Address - Country:US
Mailing Address - Phone:972-202-3423
Mailing Address - Fax:972-202-3423
Practice Address - Street 1:2101 PLANTATION LN
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75093-4220
Practice Address - Country:US
Practice Address - Phone:972-202-3423
Practice Address - Fax:972-202-3423
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-14
Last Update Date:2023-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH8624207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX098446001Medicaid
TX00G02XMedicare PIN