Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | 360087-1205 | UT |
Y | 207X00000X | Orthopaedic Surgeon | G78312 | CA |
N | 2086X0206X | Surgical Oncologist | 360087-1205 | UT |
N | 2086X0206X | Surgical Oncologist | G78312 | CA |
NPI | 1073566717 |
---|---|
Provider Name | Robert Lawrence Randall |
First Address | Sacramento, CA 95817-2307 |
Second Address | Sacramento, CA 95817 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/05/2006 |
Last Update Date | 05/09/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
D2579 | (05) | UT |
G58374 | (02) | UT |