DR. JOHN K RANDALL (NPI# 1326076530) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1326076530 |
| Entity Type | Individual |
| Full Name | DR. JOHN K RANDALL |
| Credential | RPH, MD |
| Practice Address |
124 Sagamore Pkwy W West Lafayette IN 47906-1569 |
| Mailing Address |
10223 S 400 E Lafayette IN 47909-8110 |
| Practice Telephone | 7654636722 |
| Practice Fax Number | 7654630905 |
| Mailing Telephone | 7655232344 |
| Mailing Fax Number | 7654630905 |
| Enumeration Date | 2006-06-28 |
| Last Update Date | 2007-07-09 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| X | 207N00000X | Dermatology | 01042716 | IN | Allopathic & Osteopathic Physicians |
| X | 207ND0101X |
Dermatology Specialization: MOHS-Micrographic Surgery |
01042716 | IN | Allopathic & Osteopathic Physicians |
| X | 207ND0900X |
Dermatology Specialization: Dermatopathology |
01042716 | IN | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| IN | BCBS | 000000092649 | 01 |
| DEA | BR1531385 | 01 | |
| IN | LICENSE | 01042716 | 01 |
| IN | CSR | 01042716B | 01 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1508299819 | John Wilson Randall Jr. | Social Worker | 210 Postwood Ct, Madison, AL 35758-6620 | 2013-08-11 |
| 1841206794 | John Gilbert Randall IIi | Optometrist | 2306 N Travis St, Sherman, TX 75092-2517 | 2006-07-31 |
| 1033199914 | John D Randall | Optometrist | 314 Columbia Ave, Lexington, SC 29072-2657 | 2006-01-18 |
| 1386076297 | John M. Randall | Counselor | 335 W 1st St, Oswego, NY 13126-3655 | 2013-08-01 |
| 1386906436 | John Carl Randall | Social Worker | 2273 S Vista Ave, Ste 190, Boise, ID 83705-7341 | 2012-06-14 |
| 1568794642 | John C Randall | Behavioral Analyst | 95 Washington St, Foxboro, MA 02035-1370 | 2010-02-01 |
| 1982695524 | John Wilfred Randall | Optometrist | 2043 College Way, Pacific University College of Optometry, Forest Grove, OR 97116-1756 | 2005-11-02 |
| Street Address |
124 SAGAMORE PKWY W |
| City | WEST LAFAYETTE |
| State | IN |
| Zip Code | 47906-1569 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1003876434 | Laura L Wavra | Nurse Practitioner | 124 Sagamore Pkwy W, West Lafayette, IN 47906-1569 | 2006-03-28 |
| 1164459863 | Katrina N Masterson | Nurse Practitioner | 124 Sagamore Pkwy W, West Lafayette, IN 47906-1569 | 2006-06-27 |
| 1790711828 | Theresa E Coyner | Nurse Practitioner | 124 Sagamore Pkwy W, West Lafayette, IN 47906-1569 | 2006-06-23 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1457990848 | Wickshire West Lafayette Opco LLC | Assisted Living Facility | 3575 Senior Place, West Lafayette, IN 47906 | 2020-01-02 |
| 1992290530 | Cameron Eldred | Specialist/Technologist | 3367 Edison Dr, West Lafayette, IN 47906 | 2018-06-26 |
| 1720593403 | Devin Kay Hall | Specialist/Technologist | 900 John R. Wooden Drive, West Lafayette, IN 47906 | 2017-12-04 |
| 1609398270 | Christian Floirendo | Specialist/Technologist | 2225 Willowbrook Dr, #207, West Lafayette, IN 47906 | 2017-07-14 |
| 1699176800 | Leslie Michell Pell | Registered Nurse | 1873 Kingeider Drive, West Lafayette, IN 47906 | 2014-09-07 |
| 1881007581 | Usv Optical Inc. | Eyewear Supplier (Equipment, not the service) | 2636 Us52 Sagamore Pkwy, West Lafayette, IN 47906 | 2014-06-10 |
| 1588089536 | Sarah Pierce | Pharmacist | 2636 Us 52, West Lafayette, IN 47906 | 2014-02-27 |
| 1811228240 | Angelica D. Kokkalis | Acupuncturist | 124 Westwood Dr., W. Lafayette, IN 47906 | 2010-01-25 |
| 1255529335 | Greater Lafayette Health Services | Clinic/Center | 3482 Mcclure Ave, West Lafayette, IN 47906 | 2007-10-15 |
| 1871784330 | Sally A Timmons LLC | Social Worker | 120 Sagamore Parkway West, West Lafayette, IN 47906 | 2007-08-08 |
| Find all providers in zip 47906 | ||||
| Taxonomy Code | 207N00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Dermatology |
| A dermatologist is trained to diagnose and treat pediatric and adult patients with benign and malignant disorders of the skin, mouth, external genitalia, hair and nails, as well as a number of sexually transmitted diseases. The dermatologist has had additional training and experience in the diagnosis and treatment of skin cancers, melanomas, moles and other tumors of the skin, the management of contact dermatitis and other allergic and nonallergic skin disorders, and in the recognition of the skin manifestations of systemic (including internal malignancy) and infectious diseases. Dermatologists have special training in dermatopathology and in the surgical techniques used in dermatology. They also have expertise in the management of cosmetic disorders of the skin such as hair loss and scars and the skin changes associated with aging. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: added definition, added source] Additional Resources: American Board of Dermatology, 2007. http://www.abderm.org/ Board certification is provided by the American Board of Dermatology. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1457998692 | Medovate, LLC | Dermatology | 9305 Calumet Ave Ste A1, Munster, IN 46321-2888 | 2019-12-06 |
| 1386107829 | Strausburg Dermatology Group LLC | Dermatology | 92 S Park Blvd, Greenwood, IN 46143-8836 | 2019-04-11 |
| 1467834127 | Emily W Shelley | Dermatology | 8433 Harcourt Rd Ste 310, Indianapolis, IN 46260-2198 | 2015-06-18 |
| 1396133518 | Forefront Dermatology, S.c. | Dermatology | 188 State Road 129 S. Ste B, Batesville Medical Arts Bldg, Batesville, IN 47006 | 2014-12-23 |
| 1003211392 | Forefront Dermatology, S.c. | Dermatology | 1473 N Gardner St Ste A, C/o Scott Memorial Hospital, Scottsburg, IN 47170 | 2014-10-29 |
| 1639580152 | Nikolajs Perdue | Dermatology | 6820 Parkdale Pl Ste 211, Indianapolis, IN 46254-6600 | 2014-05-19 |
| 1356785778 | Larry Gene Bond | Dermatology | 9637 W. County Rd 200 N., Frankfort, IN 46041 | 2013-04-29 |
| 1093057911 | Matthew Bradley Strausburg | Dermatology | 9292 N Meridian St Ste 210, Indianapolis, IN 46260-1828 | 2013-03-18 |
| 1730430513 | Robert Marshall Weiss | Dermatology | 6017 Benchmark-one, Floyds Knobs, IN 47119-9410 | 2012-09-20 |
| 1346597655 | Franciscan Medical Specialists | Dermatology | 757-45th Street, Ste 201, Munster, IN 46321 | 2012-08-07 |
| Find all providers with the same taxonomy | ||||
| City | WEST LAFAYETTE |
| Zip Code | 47906 |
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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.