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Brent Randall
NPI 1497913123 · on the registry since 2008 · sole proprietor
Practice
- Address
- 302 Garnet Dr
Kimberly, ID 83341 - Phone
- (208) 731-9799
Registry record
- Primary taxonomy
- 225X00000X
225X00000X
- Licence states on file
- ID
From the registry's licence fields, which are often incomplete.
- Sex
- Male
- Record last updated
- 2008-05-29
Source: CMS National Plan and Provider Enumeration System. Registration is not the same as practising, and the registry records no retirement — some people listed here no longer practise. More in Idaho