Randolph, Tommy Lavaughn

Randolph, Tommy Lavaughn is an individual health care provider with primary practice located at 1847 Sw Barnett Way , Lake City FL 32025-6957. He recently has only one registered license in Allopathic & Osteopathic Physicians / Family Medicine, which is considered as his primary health care specialty. Randolph, Tommy Lavaughn can be contacted via phone (386) 755-1440.

Contact Information

Primary practice address
1847 Sw Barnett Way Lake City FL 32025-6957
Phone: (386) 755-1440
Fax: (386) 758-5628
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Family Medicine 207Q00000X ME46235 Florida

Profile Details

NPI number 1992805881
LBN Legal business name Randolph, Tommy Lavaughn
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Sep 22nd, 2006
Last updated Jan 3rd, 2014 - about 10 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1992805881 NPPES
Florida Other 12070 BCBS
Florida Other 080154675 BCBS
Florida Other 030335 BCBS
Florida Other 1992805881 BCBS
Florida MEDICAID 041374700 BCBS
Florida Other 0004055514 BCBS

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