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General NPI Number Information
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NPI Number | 1548473069
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Entity Type | Individual
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Provider Name | RANDALL RASMUSSEN M.D.
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Gender | Male
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Dates
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Enumeration Date | 05/08/2007
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Last Update Date | 06/24/2016
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Provider Practice Location Address
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Address Line | 251 BIRCHWOOD DR
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City | MORAGA
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State | CA
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Zip | 94556-2302
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Country | US
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Telephone | 847-388-2065
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Fax | 866-720-9740
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Provider Business Mailing Address
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Address Line | 251 BIRCHWOOD DR
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City | MORAGA
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State | CA
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Zip | 94556-2302
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Country | US
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Telephone | 847-388-2065
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Fax | 866-720-9740
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | G32691
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License Number State | CA
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