Provider Demographics
NPI:1700883600
Name:BARNETT, RANDALL DEAN (MD)
Entity type:Individual
Prefix:DR
First Name:RANDALL
Middle Name:DEAN
Last Name:BARNETT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5405 S 500 E
Mailing Address - Street 2:SUITE 101
Mailing Address - City:OGDEN
Mailing Address - State:UT
Mailing Address - Zip Code:84405-6957
Mailing Address - Country:US
Mailing Address - Phone:801-689-3500
Mailing Address - Fax:801-689-3505
Practice Address - Street 1:5405 S 500 E
Practice Address - Street 2:SUITE 101
Practice Address - City:OGDEN
Practice Address - State:UT
Practice Address - Zip Code:84405-6957
Practice Address - Country:US
Practice Address - Phone:801-689-3500
Practice Address - Fax:801-689-3505
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-07
Last Update Date:2013-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT94-272450-1250173000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes173000000XOther Service ProvidersLegal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT005563402Medicare PIN
UTF7610Medicare UPIN