Braddom, Randall L

Braddom, Randall L is an sole proprietor health care provider with primary practice located at 1093 Golden Grove Dr , The Villages FL 32162-4023. He recently has only one registered license in Allopathic & Osteopathic Physicians / Physical Medicine & Rehabilitation, which is considered as his primary health care specialty. Braddom, Randall L can be contacted via phone (908) 601-7036.

Contact Information

Primary practice address
1093 Golden Grove Dr The Villages FL 32162-4023
Phone: (908) 601-7036
Fax: (352) 561-4512
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Physical Medicine & Rehabilitation 208100000X 25MA02637400 New Jersey

Profile Details

NPI number 1255302360
LBN Legal business name Braddom, Randall L
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 Yes
Enumeration date Jan 27th, 2006
Last updated Jun 3rd, 2013 - about 13 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 1255302360 NPPES
New Jersey MEDICAID 9074201

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