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:
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Health care specialties

SpecialtyCodeLicense #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 2 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 1841233186 NPPES
Wisconsin MEDICAID 41958200

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