MEDICARE: DR. RANDALL BRADLEY WEIL M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208200000X	Plastic Surgery Physician	C36883	CA

General Provider Information

NPI Number	:	1275568412
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RANDALL BRADLEY WEIL M.D.

Provider Business Mailing Address
First Line	:	909 HYDE ST
Second Line	:	SUITE 602
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94109-4822
Country	:	US
Telephone Number	:	415-781-2081
Fax Number	:	415-567-1402

Provider Business Practice Location Address
First Line	:	909 HYDE ST
Second Line	:	SUITE 602
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94109-4822
Country	:	US
Telephone Number	:	415-781-2081
Fax Number	:	415-567-1402

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/12/2006
Last Update Date	:	07/08/2007

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