Provider Demographics
NPI:1861421489
Name:RAZIANO, RANDALL MICHAEL (MD)
Entity type:Individual
Prefix:DR
First Name:RANDALL
Middle Name:MICHAEL
Last Name:RAZIANO
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:PO BOX 1301
Mailing Address - Street 2:
Mailing Address - City:MONTROSE
Mailing Address - State:CO
Mailing Address - Zip Code:81402-1301
Mailing Address - Country:US
Mailing Address - Phone:970-497-8416
Mailing Address - Fax:970-497-8410
Practice Address - Street 1:800 S 3RD ST
Practice Address - Street 2:
Practice Address - City:MONTROSE
Practice Address - State:CO
Practice Address - Zip Code:81401-4212
Practice Address - Country:US
Practice Address - Phone:970-249-2211
Practice Address - Fax:970-240-7745
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2025-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM30682085R0202X, 2085R0204X
NC2005-005992085R0202X, 2085R0204X
LAMD2000872085R0202X, 2085R0204X
FLME935392085R0202X, 2085R0204X
GA0494982085R0202X, 2085R0204X
CODR-448562085R0202X, 2085R0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO77732332Medicaid
CO92927246Medicaid
CO77032332Medicaid
COC809733Medicare PIN
LA4J787C958Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER
CO806211Medicare ID - Type UnspecifiedCO MEDICARE
CO92927246Medicaid