Mckissack, Randall Louis

Mckissack, Randall Louis is an individual health care provider with primary practice located at 999 Mar Walt Dr , Fort Walton Beach FL 32547-6758. He recently has only one registered license in Allopathic & Osteopathic Physicians / Surgery, which is considered as his primary health care specialty. Mckissack, Randall Louis can be contacted via phone (850) 863-8269.

Contact Information

Primary practice address
999 Mar Walt Dr Fort Walton Beach FL 32547-6758
Phone: (850) 863-8269
Fax: (850) 862-7965
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Surgery 208600000X ME96715 Florida

Profile Details

NPI number 1487639621
LBN Legal business name Mckissack, Randall Louis
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Dec 9th, 2005
Last updated Nov 12th, 2020 - about 6 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 1487639621 NPPES
Florida MEDICAID 277632400

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