GARY MILTON RANDALL (NPI# 1194733733) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1194733733 |
| Entity Type | Individual |
| Full Name | GARY MILTON RANDALL |
| Credential | D.O. |
| Practice Address |
100 W Southlake Blvd Ste 410 Southlake TX 76092-6166 |
| Mailing Address |
1250 S Clearview Ave Ste 100 Mesa AZ 85209-3378 |
| Practice Telephone | 8172004421 |
| Mailing Telephone | 4809889108 |
| Mailing Fax Number | 4808134460 |
| Enumeration Date | 2006-08-03 |
| Last Update Date | 2019-07-15 |
| NPI Deactivation Date | 05/20/2019 |
| NPI Reactivation Date | 2019-06-06 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207Q00000X | Family Medicine | 006034 | AZ | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| AZ | 832035 | 05 | |
| AZ | MEDICARE PTAN | Z160362 | 01 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1104165323 | Gary Cagan Randall | Chiropractor | 100 W Southlake Blvd Ste 410, Southlake, TX 76092-6166 | 2013-02-07 |
| 1447647961 | Gary R Randall | Counselor | 762 Falls Ave, Twin Falls, ID 83301-3316 | 2015-04-22 |
| 1962818740 | Gary Randall | Social Worker | 209 E Lewis St, Pocatello, ID 83201-6465 | 2014-07-01 |
| Street Address |
100 W SOUTHLAKE BLVD STE 410 |
| City | SOUTHLAKE |
| State | TX |
| Zip Code | 76092-6166 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1346216660 | Karen Shalini Harmon | Physical Therapist | 100 W Southlake Blvd, #420, Southlake, TX 76092 | 2006-02-27 |
| 1477928273 | Texas Integrated Healthcare Solutions Pllc | General Practice | 100 W Southlake Blvd, Southlake, TX 76092-6100 | 2015-12-04 |
| 1851796932 | Elite Wellness and Weight Loss | General Practice | 100 W Southlake Blvd, Ste 180, Southlake, TX 76092-6100 | 2014-10-30 |
| 1205199684 | Meehan Sports Therapy & Pediatrics Pllc | Clinic/Center | 100 W Southlake Blvd, Ste 420, Southlake, TX 76092-6100 | 2012-06-20 |
| 1053630327 | Southlake Health P.C. | Chiropractor | 100 W Southlake Blvd, Suite # 410, Southlake, TX 76092-6100 | 2010-05-25 |
| 1033373113 | Khaldoun F Al-ajlouni | Dentist | 100 W Southlake Blvd, Ste 146, Southlake, TX 76092-6100 | 2008-07-17 |
| 1134398753 | Franchisee of Foot Solutions | Prosthetic/Orthotic Supplier | 100 W Southlake Blvd, Suite 144, Southlake, TX 76092-6100 | 2008-02-28 |
| 1033242946 | Davinci Dentistry | Dentist | 100 W Southlake Blvd, Suite 146, Southlake, TX 76092-6104 | 2007-03-13 |
| 1952379752 | Leslie Leah Williams | Physical Therapist | 100 W Southlake Blvd, Suite 420, Southlake, TX 76092-6166 | 2006-03-09 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1730718990 | Elizabeth Beazley | Family Medicine | 1050 E. Hwy 114 Suite 100, Southlake, TX 76092 | 2020-04-08 |
| 1518508894 | Arbor Pediatrics, Pllc | Pediatrics | 1130 N Kimball Ave, Southlake, TX 76092 | 2019-10-08 |
| 1346882685 | Gs Ortho Assists, Pllc | Physician Assistant | 2600 East Southlake Boulevard Suite 120, Southlake, TX 76092 | 2019-10-08 |
| 1609340496 | Rebecca Leigh Lander | Physician Assistant | 1170 N Carroll Ave., Southlake, TX 76092 | 2019-01-15 |
| 1225506223 | Physicians Wellness Associates Pllc | Family Medicine | 1920 East State Highway 114, Southlake, TX 76092 | 2018-11-07 |
| 1740762459 | Brandi L. Barker | Chiropractor | 590 N. Kimball Ave, Suite 140, Southlake, TX 76092 | 2018-08-30 |
| 1033699228 | Julie A. Seeber | Physical Therapy Assistant | 170 Stonebridge Lane, Southlake, TX 76092 | 2018-08-16 |
| 1992281364 | Alayna Powers | Nurse Practitioner | 900 E Southlake Blvd Ste 300, Southlake, TX 76092 | 2018-07-18 |
| 1346732153 | Amrittej Singh Virk | Dentist | 630 N Kimball Ave Ste 110, Southlake, TX 76092 | 2018-06-06 |
| 1740779594 | Radiant Family Dental Pllc | Dentist | 2012 Southlake Glen Dr., Southlake, TX 76092 | 2018-05-08 |
| Find all providers in zip 76092 | ||||
| Taxonomy Code | 207Q00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Family Medicine |
| Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity. |
| Notes: Source: American Board of Family Medicine [1/1/2007: changed title; 7/1/2007: added definition, added source; 7/1/2017: modified definition] - Note: The American Osteopathic Board of Family Physicians certification includes extensive use of Osteopathic Manipulative Treatment (OMT), which integrates the biological, clinical, and behavioral sciences. - Additional Resources: American Board of Family Medicine, www.theabfm.org. American Osteopathic Board of Family Physicians, www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Family Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Family Physicians or the American Board of Family Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1730718990 | Elizabeth Beazley | Family Medicine | 1050 E. Hwy 114 Suite 100, Southlake, TX 76092 | 2020-04-08 |
| 1225506223 | Physicians Wellness Associates Pllc | Family Medicine | 1920 East State Highway 114, Southlake, TX 76092 | 2018-11-07 |
| 1518443142 | Rachel Ann Roten | Family Medicine | 900 E Southlake Blvd Ste 200, Southlake, TX 76092-6376 | 2018-07-17 |
| 1043720154 | Healthcare Associates of Southlake LLP | Family Medicine | 2106 E State Highway 114, Ste 300, Southlake, TX 76092 | 2017-10-03 |
| 1538683289 | Nicole Butler | Family Medicine | 620 N Kimball Ave Ste 100, Southlake, TX 76092-6856 | 2017-08-02 |
| 1699132233 | Bull Care, Pllc | Family Medicine | 3120 W Southlake Blvd Ste 100, Southlake, TX 76092-6784 | 2016-01-27 |
| 1851760979 | Colleyville Md Associates | Family Medicine | 305 Boulder Dr, Southlake, TX 76092-3726 | 2015-09-18 |
| 1013391184 | Mediclink Management Group | Family Medicine | 415 E Southlake Blvd Ste 100, Southlake, TX 76092-6279 | 2015-07-17 |
| 1164800744 | William Robert Peeler | Family Medicine | 905 Chimney Hill Trl, Southlake, TX 76092 | 2015-05-14 |
| 1497148613 | Kara Charlotte Farley | Family Medicine | 105 Clariden Ranch Road, Southlake, TX 76092-1133 | 2015-03-12 |
| Find all providers in SOUTHLAKE | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.