Healthcare Provider Details

I. General information

NPI: 1245220060
Provider Name (Legal Business Name): RANDALL ROBERT STARKEY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/24/2005
Last Update Date: 05/17/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5401 NORRIS CANYON RD SUITE 306
SAN RAMON CA
94583-5409
US

IV. Provider business mailing address

2350 W EL CAMINO REAL FL 2
MOUNTAIN VIEW CA
94040-6203
US

V. Phone/Fax

Practice location:
  • Phone: 925-277-0101
  • Fax: 925-277-9086
Mailing address:
  • Phone: 510-204-8140
  • Fax: 510-849-0159

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084N0600X
TaxonomyClinical Neurophysiology Physician
License NumberG51831
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberG51831
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: