Woodworth, Randon Blake

Woodworth, Randon Blake is an individual health care provider with primary practice located at 407 W 66Th St , Richfield MN 55423-2374. He recently has only one registered license in Allopathic & Osteopathic Physicians / Family Medicine, which is considered as his primary health care specialty. Woodworth, Randon Blake can be contacted via phone (612) 798-8800.

Contact Information

Primary practice address
407 W 66Th St Richfield MN 55423-2374
Phone: (612) 798-8800
Fax: (612) 798-8816
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Family Medicine 207Q00000X 27725 Minnesota

Profile Details

NPI number 1639130826
LBN Legal business name Woodworth, Randon Blake
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Mar 29th, 2006
Last updated Mar 11th, 2021 - about 4 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 1639130826 NPPES
Minnesota MEDICAID 510877200

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