Provider Demographics
NPI:1750559605
Name:BOESPFLUG, RANDOLPH ROY (MD MBA)
Entity type:Individual
Prefix:DR
First Name:RANDOLPH
Middle Name:ROY
Last Name:BOESPFLUG
Suffix:
Gender:M
Credentials:MD MBA
Other - Prefix:DR
Other - First Name:RANDY
Other - Middle Name:ROY
Other - Last Name:BOESPFLLUG
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD MBA
Mailing Address - Street 1:380 9TH ST
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:OR
Mailing Address - Zip Code:97439-9470
Mailing Address - Country:US
Mailing Address - Phone:541-997-7134
Mailing Address - Fax:541-997-9650
Practice Address - Street 1:380 9TH ST
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:OR
Practice Address - Zip Code:97439-9470
Practice Address - Country:US
Practice Address - Phone:541-997-7134
Practice Address - Fax:541-997-9650
Is Sole Proprietor?:No
Enumeration Date:2008-02-13
Last Update Date:2009-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD15363207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR177659OtherDMAP
OR1750559605OtherNPI
OR177659OtherDMAP
OR1750559605OtherNPI