DERRICK RANDDOLF (NPI# 1104205343) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1104205343 |
| Entity Type | Individual |
| Full Name | DERRICK RANDDOLF |
| Credential | MD |
| Practice Address |
701 W 5th St Odessa TX 79763-4206 |
| Practice Telephone | 4327035375 |
| Practice Fax Number | 4327035238 |
| Mailing Telephone | 4327035375 |
| Mailing Fax Number | 4327035238 |
| Enumeration Date | 2015-05-20 |
| Last Update Date | 2019-07-13 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207Q00000X | Family Medicine | R4622 | TX | Allopathic & Osteopathic Physicians |
| N | 390200000X | Student in an Organized Health Care Education/Training Program | Student, Health Care |
| Street Address |
701 W 5TH ST |
| City | ODESSA |
| State | TX |
| Zip Code | 79763-4206 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1407845084 | Texas Tech University Health Sciences Center Odessa | Internal Medicine | 701 W 5th St, Odessa, TX 79763-4206 | 2005-10-17 |
| 1568075117 | Bibek Bakhati | Student in an Organized Health Care Education/Training Program | 701 W 5th St, Odessa, TX 79763-4206 | 2020-08-24 |
| 1972112852 | Priya Darshini Velumani | Internal Medicine | 701 W 5th St, Odessa, TX 79763-4206 | 2020-07-28 |
| 1811505274 | Hina Tariq | Student in an Organized Health Care Education/Training Program | 701 W 5th St, Odessa, TX 79763-4206 | 2020-07-21 |
| 1710595350 | Prince Richardson Lemuel Ernest | Student in an Organized Health Care Education/Training Program | 701 W 5th St, Odessa, TX 79763-4206 | 2020-07-20 |
| 1952939951 | Goutami Mangu | Student in an Organized Health Care Education/Training Program | 701 W 5th St, Odessa, TX 79763-4206 | 2020-03-27 |
| 1790337483 | Mandeep Kaur Sidhu | Student in an Organized Health Care Education/Training Program | 701 W 5th St, Odessa, TX 79763-4206 | 2019-07-12 |
| 1174185292 | Andrey Mironenko | Student in an Organized Health Care Education/Training Program | 701 W 5th St, Odessa, TX 79763-4206 | 2019-06-29 |
| 1043872120 | Govind Jha | Student in an Organized Health Care Education/Training Program | 701 W 5th St, Odessa, TX 79763-4206 | 2019-06-28 |
| 1447811682 | Juan Guillermo Sierra David | Student in an Organized Health Care Education/Training Program | 701 W 5th St, Odessa, TX 79763-4206 | 2019-06-27 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1578164885 | Mary Ewusie | Pharmacist | 2450 West Loop 3378, Odessa, TX 79763 | 2020-11-03 |
| 1982231569 | Yashica Patel | Student in an Organized Health Care Education/Training Program | 701 W. 5th St, Suite 1229, Odessa, TX 79763 | 2020-03-24 |
| 1144740457 | Devi Priya Suravajjala | Student in an Organized Health Care Education/Training Program | 701,w 5th Street, Odessa, TX 79763 | 2017-06-27 |
| 1649640392 | Elesea Celeste Villegas | Physician Assistant | 701 West 5th Street, Odessa, TX 79763 | 2015-10-06 |
| 1790046472 | Kathryn Nichole Hutton | Obstetrics & Gynecology | 701 W 5th Street, Odessa, TX 79763 | 2012-05-30 |
| 1962761791 | Marvin Ryan Harvey | Family Medicine | 701 W 5th St Ste 3174, Odessa, TX 79763 | 2012-05-14 |
| 1245529544 | Yvette Garcia | Counselor | 1012 W Macarthur, Odessa, TX 79763 | 2011-04-07 |
| 1386973873 | Patty Denise Pena | Pharmacist | 1305 W County Rd, Odessa, TX 79763 | 2009-12-14 |
| 1508002262 | Javier E Espinoza | Physician Assistant | 1220 W. University, Odessa, TX 79763 | 2008-12-31 |
| 1952584690 | J A Mayans Md Pa | Ophthalmology | 907 W Second St, Odessa, TX 79763 | 2007-12-17 |
| Find all providers in zip 79763 | ||||
| Taxonomy Code | 207Q00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Family Medicine |
| Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity. |
| Notes: Source: American Board of Family Medicine [1/1/2007: changed title; 7/1/2007: added definition, added source; 7/1/2017: modified definition] - Note: The American Osteopathic Board of Family Physicians certification includes extensive use of Osteopathic Manipulative Treatment (OMT), which integrates the biological, clinical, and behavioral sciences. - Additional Resources: American Board of Family Medicine, www.theabfm.org. American Osteopathic Board of Family Physicians, www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Family Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Family Physicians or the American Board of Family Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1376150102 | Paul Joseph Baquirin | Family Medicine | 1403 E Century Ave, Odessa, TX 79762-7743 | 2020-09-25 |
| 1972868974 | Carehere LLC | Family Medicine | 2330 W 10th St, Odessa, TX 79763-3782 | 2012-07-06 |
| 1376807362 | Mavis Twum-barimah | Family Medicine | 6030 W University Blvd, Odessa, TX 79764-8530 | 2012-06-25 |
| 1962761791 | Marvin Ryan Harvey | Family Medicine | 701 W 5th St Ste 3174, Odessa, TX 79763 | 2012-05-14 |
| 1841576378 | Ashley Burdex | Family Medicine | 6030 W University, Odessa, TX 79761 | 2011-10-28 |
| 1043517204 | Scotty Ortega Pa | Family Medicine | 4415 Hinkle St, Odessa, TX 79762-4626 | 2011-02-23 |
| 1265763130 | Robert James Ailes | Family Medicine | 16641 Ivy Lake Dr, Odessa, FL 33556-6019 | 2010-01-16 |
| 1609020452 | Leo Villaroman, Md, Pa | Family Medicine | 501 Golder Ave, Suite 203, Odessa, TX 79761-4411 | 2008-11-06 |
| 1568640365 | John Garcia Md Pa | Family Medicine | 601 East 7th Street, Odessa, TX 79761 | 2008-02-04 |
| 1023224904 | Odessa Medical Clinic PC | Family Medicine | 316 W Us Highway 40, Odessa, MO 64076-7445 | 2007-05-15 |
| Find all providers in ODESSA | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.