1851975056 NPI number — DR. AUSTIN GONZALEZ-RANDOLPH LP

Table of content: DR. AUSTIN GONZALEZ-RANDOLPH LP (NPI 1851975056)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1851975056 NPI number — DR. AUSTIN GONZALEZ-RANDOLPH LP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GONZALEZ-RANDOLPH
Provider First Name:
AUSTIN
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
LP
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1851975056
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/06/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
100 N HOWARD ST STE R
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SPOKANE
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
99201-0508
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
425-780-5094
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
214 MAPLE ST UNIT B
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WAUSAU
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
54401-4425
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
425-780-5094
Provider Business Practice Location Address Fax Number:
425-537-6473
Provider Enumeration Date:
05/12/2021

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 103T00000X , with the licence number:  PY61278527 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 103T00000X , with the licence number: 4078-57 , registered in the state of WI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2025 www.npivalidator.com