Healthcare Provider Details

I. General information

NPI: 1073566717
Provider Name (Legal Business Name): ROBERT LAWRENCE RANDALL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/17/2006
Last Update Date: 09/05/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4860 Y ST STE 1700
SACRAMENTO CA
95817
US

IV. Provider business mailing address

4860 Y ST STE 3800
SACRAMENTO CA
95817-2307
US

V. Phone/Fax

Practice location:
  • Phone: 916-734-3398
  • Fax:
Mailing address:
  • Phone: 916-734-5885
  • Fax: 916-734-7904

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number360087-1205
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code2086X0206X
TaxonomySurgical Oncology Physician
License Number360087-1205
License Number StateUT
# 3
Primary TaxonomyN
Taxonomy Code2086X0206X
TaxonomySurgical Oncology Physician
License NumberG78312
License Number StateCA
# 4
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberG78312
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: