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GERALD G. RANDOLPH, M.D., INC., P.S.

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Company Details

Legal Name: GERALD G. RANDOLPH, M.D., INC., P.S.
Jurisdiction: WASHINGTON
Entity Type: WA PROFESSIONAL SERVICE CORPORATION
Category: DOMESTIC ENTITY
Status: Voluntarily Dissolved
Formation/ Registration Date: February 4th 1977
Date of Dissolution: February 14th 2018
Expiration date: 28 Feb 2018
UBI Number: 600 222 202

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Registered Agent Information

Name Role Address
DAN RANDOLPH Registered Agent 16400 SOUTHCENTER PRKY #514, TUKWILA, WA, 98188-0000, UNITED STATES

Key Officers & Management

Name Role Address
GERALD RANDOLPH Governing Person 10491 EAST STATE ROUTE 106, UNION, WA, 98592, UNITED STATES

National Provider Identifier

NPI Number:
1013131374

Authorized Person:

Name:
DR. GERALD GUY RANDOLPH
Role:
PRESIDENT
Phone:

Taxonomy:

Selected Taxonomy:
261QM2500X - Medical Specialty Clinic/Center
Is Primary:
Yes

Contacts:

Fax:
2065752874
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