Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Y00000X | Otolaryngologist (ENT Doctor) | 17690 | NC |
N | 207Y00000X | Otolaryngologist (ENT Doctor) | G35715 | CA |
N | 207YX0007X | Plastic Surgeon (Head & Neck) | 17690 | NC |
Y | 207YX0007X | Plastic Surgeon (Head & Neck) | G35715 | CA |
N | 207YX0905X | Otolaryngology/Facial Plastic Surgery | 17690 | NC |
N | 207YX0905X | Otolaryngology/Facial Plastic Surgery | G35715 | CA |
NPI | 1225062623 |
---|---|
Provider Name | Dr. Randall George Michel |
First Address | Lompoc, CA 93436-7002 |
Second Address | Lompoc, CA 93436-7002 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/07/2006 |
Last Update Date | 27/05/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00G357150 | (05) | CA |
A46451 | (02) | CA |