Healthcare Provider Details

I. General information

NPI: 1548254139
Provider Name (Legal Business Name): RANDY P. HAUSTED M.D. INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/09/2005
Last Update Date: 08/05/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 WOODLAND RD
ST. HELENA CA
94574-9554
US

IV. Provider business mailing address

PO BOX 270067
SAINT LOUIS MO
63127-0067
US

V. Phone/Fax

Practice location:
  • Phone: 707-963-6288
  • Fax: 707-967-5684
Mailing address:
  • Phone: 707-241-8205
  • Fax: 314-856-0635

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number
License Number State

VIII. Authorized Official

Name: RANDY P HAUSTED
Title or Position: OWNER/ PATHOLOGIST
Credential: M.D.
Phone: 707-963-6288