Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
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Dr. Randall Louis McKissack, MD

Individual provider Surgery Physician · NPI 1487639621

Dr. Randall Louis McKissack, MD is a General Surgery in Fort Walton Beach, Florida. Graduated from University of Alabama School of Medicine in 1986, 40 years ago. Practices with White-Wilson Medical Center PA, a 47-clinician group and accepts Medicare assignment. Licensed in Florida.

Years since qualifying
40
Trained at
University of Alabama School of Medicine
Licensed in
FL
In the registry since
2005
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

999 Mar Walt Dr
Fort Walton Beach, FL 32547-6758
Phone: (850) 863-8269
Fax: (850) 862-7965
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Surgery Physician (primary) Taxonomy 208600000X · Licence ME96715 (FL)

Record details

NPI number1487639621
Entity typeIndividual (Type 1)
GenderMale
Credentials MD
Sole proprietorNo
NPI enumeratedDecember 9, 2005
Last updated in NPPESNovember 12, 2020
Certification dateNovember 12, 2020
Mailing address1005 Mar Walt Drive, Fort Walton Beach, FL 32547-6707

Medicare enrollment

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

Medicare specialtyGENERAL SURGERY
Medical schoolUNIVERSITY OF ALABAMA SCHOOL OF MEDICINE
Graduated 1986 (40 years in practice)
Group practice White-Wilson Medical Center Pa — 47 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount

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