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General NPI Number Information
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NPI Number | 1548254139
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Entity Type | Organization
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Legal Business Name | RANDY P. HAUSTED M.D. INC
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Dates
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Enumeration Date | 09/09/2005
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Last Update Date | 08/05/2014
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Provider Practice Location Address
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Address Line | 10 WOODLAND RD
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City | ST. HELENA
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State | CA
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Zip | 94574-9554
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Country | US
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Telephone | 707-963-6288
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Fax | 707-967-5684
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Provider Business Mailing Address
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Address Line | PO BOX 270067
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City | SAINT LOUIS
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State | MO
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Zip | 63127-0067
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Country | US
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Telephone | 707-241-8205
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Fax | 314-856-0635
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Authorized Official
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Title or Position | OWNER/ PATHOLOGIST
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Name | RANDY P HAUSTED
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Credential | M.D.
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Telephone | 707-963-6288
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207ZP0102X
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Taxonomy Name | Anatomic Pathology & Clinical Pathology Physician
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License Number |
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License Number State |
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