MEDICARE: DR. RANDAL ALLEN OSTER PH.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103T00000X	Psychologist	109512-2501	UT

General Provider Information

NPI Number	:	1184650467
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RANDAL ALLEN OSTER PH.D.

Provider Business Mailing Address
First Line	:	2040 MURRAY HOLLADAY RD
Second Line	:	SUITE 211
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84117-5185
Country	:	US
Telephone Number	:	801-272-5083
Fax Number	:	801-272-5094

Provider Business Practice Location Address
First Line	:	2040 MURRAY HOLLADAY RD
Second Line	:	SUITE 211
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84117-5185
Country	:	US
Telephone Number	:	801-272-5083
Fax Number	:	801-272-5094

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/25/2006
Last Update Date	:	07/08/2007

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