| Organization Name: | CLEVELAND W. RANDOLPH JR MD,PA |
| NPI Number: | 1497808182 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | CLEVELAND W RANDOLPH (PHYSICIAN) |
| Mailing Address: | 1891 Beach Blvd Ste 200 Jacksonville Beach |
| State: | FL US |
| Postal Code: | 322502644 |
| Phone Number: | 9042493743 |
| Fax Number: | 9042492047 |
| NPI Enumeration Date: | 01/18/2007 |
| NPI Last Update Date: | 08/18/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 174400000X |
| License Number: | ME0042493 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | FL |
| Taxonomy Type: | Other Service Providers |
| Taxonomy Classification: | Specialist |
| Taxonomy Specialization: | |
| Taxonomy Definition: | An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree. |