MEDICARE: DR. RANDALL LEE BIVENS M.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	2085R0202X	Diagnostic Radiology Physician	G40956	CA

General Provider Information

NPI Number	:	1922180207
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RANDALL LEE BIVENS M.D.

Provider Business Mailing Address
First Line	:	PO BOX 869
Second Line	:	800 DUNCAN SPRINGS RD
City	:	HOPLAND
State	:	CA
Zip	:	95449-0869
Country	:	US
Telephone Number	:	707-744-8500
Fax Number	:

Provider Business Practice Location Address
First Line	:	800 DUNCAN SPRINGS RD
Second Line	:
City	:	HOPLAND
State	:	CA
Zip	:	95449-9762
Country	:	US
Telephone Number	:	707-744-8500
Fax Number	:

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

Provider Enumeration Date	:	10/19/2006
Last Update Date	:	01/10/2011

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