Provider Demographics
NPI:1609600139
Name:WAX, RANDY STUART (MD, MED, FCCM)
Entity type:Individual
Prefix:DR
First Name:RANDY
Middle Name:STUART
Last Name:WAX
Suffix:
Gender:M
Credentials:MD, MED, FCCM
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Mailing Address - Street 1:1 HOSPITAL COURT
Mailing Address - Street 2:OFFICE OF THE CHIEF OF STAFF, LAKERIDGE HEALTH
Mailing Address - City:OSHAWA
Mailing Address - State:ZZ - FOREIGN COUNTRIES
Mailing Address - Zip Code:L1G 2B9
Mailing Address - Country:CA
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1 HOSPITAL COURT
Practice Address - Street 2:OFFICE OF THE CHIEF OF STAFF, LAKERIDGE HEALTH
Practice Address - City:OSHAWA
Practice Address - State:ZZ - FOREIGN COUNTRIES
Practice Address - Zip Code:L1G 2B9
Practice Address - Country:CA
Practice Address - Phone:905-576-8711
Practice Address - Fax:416-907-3411
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-28
Last Update Date:2024-08-28
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Provider Licenses
StateLicense IDTaxonomies
MI4301111223207RC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine