Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Derrick Randdolf, MD

Individual provider Emergency Medicine Physician · NPI 1104205343

Derrick Randdolf, MD is a Family Practice in Odessa, Texas. Qualified in 2012, 14 years ago. Practices with Concord Medical Group of Texas PLLC, a 317-clinician group and accepts Medicare assignment. Licensed in Texas.

Years since qualifying
14
Licensed in
TX
In the registry since
2015
Specialties on file
2
What do these letters mean?
MD — Doctor of Medicine
A physician who completed allopathic medical school.

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Practice location Address checks out

701 W 5th St
Odessa, TX 79763-4206
Phone: (432) 703-5375
Fax: (432) 703-5238
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Family Medicine Physician (primary) Taxonomy 207Q00000X · Licence R4622 (TX)
Emergency Medicine Physician Taxonomy 207P00000X · Licence R4622 (TX)

Record details

NPI number1104205343
Entity typeIndividual (Type 1)
GenderMale
Credentials MD
Sole proprietorNo
NPI enumeratedMay 20, 2015
Last updated in NPPESFebruary 26, 2025
Certification dateFebruary 26, 2025
Mailing address24165 W Interstate 10 Ste 202, San Antonio, TX 78257-1160

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyFAMILY PRACTICE
Also practisesEMERGENCY MEDICINE
Medical schoolOTHER
Graduated 2012 (14 years in practice)
Group practice Concord Medical Group Of Texas Pllc — 317 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
Practice locations4 on file with Medicare

Other providers in Odessa