Southards, Randall R
Southards, Randall R is an individual health care provider with primary practice located at 2845 Greenbrier Rd Ste 320 , Green Bay WI 54311-6519. He recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant, which is considered as his primary health care specialty. Southards, Randall R can be contacted via phone (920) 288-8320.Contact Information
Primary practice address
2845 Greenbrier Rd Ste 320
Green Bay WI 54311-6519
Phone: (920) 288-8320
Fax: (920) 288-8325
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant | 363A00000X | 1402 | Wisconsin |
Profile Details
| NPI number | 1841233186 |
|---|---|
| LBN Legal business name | Southards, Randall R |
| Credentials | Physician Assistant (PA) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Jun 14th, 2006 |
| Last updated | Feb 16th, 2024 - about 10 months 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.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1841233186 | NPPES |
| Wisconsin | MEDICAID | 41958200 |
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