Provider Demographics
NPI:1023496957
Name:IP, RANDY JAMES (DO)
Entity type:Individual
Prefix:
First Name:RANDY
Middle Name:JAMES
Last Name:IP
Suffix:
Gender:M
Credentials:DO
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Mailing Address - Street 1:6355 S BUFFALO DR FL 3
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89113-2133
Mailing Address - Country:US
Mailing Address - Phone:702-216-3346
Mailing Address - Fax:702-671-6883
Practice Address - Street 1:2865 SIENA HEIGHTS DR STE 331
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89052-4171
Practice Address - Country:US
Practice Address - Phone:702-407-0110
Practice Address - Fax:702-407-0133
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-12
Last Update Date:2022-10-25
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Provider Licenses
StateLicense IDTaxonomies
MI5101021664207R00000X
NVDO2923207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVDO2923OtherSTATE LICENSE