MEDICARE: RANDALL A OW

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	207Y00000X	Otolaryngology Physician	G86601	CA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	040017418	OTHER	CA	RR MEDICARE PIN

General Provider Information

NPI Number	:	1336142009
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RANDALL A OW

Provider Business Mailing Address
First Line	:	1111 EXPOSITION BLVD
Second Line	:	BLDG 700
City	:	SACRAMENTO
State	:	CA
Zip	:	95815-4314
Country	:	US
Telephone Number	:	916-736-3408
Fax Number	:	916-233-4171

Provider Business Practice Location Address
First Line	:	2 MEDICAL PLAZA DR
Second Line	:	STE 225 & 235
City	:	ROSEVILLE
State	:	CA
Zip	:	95661-3043
Country	:	US
Telephone Number	:	916-782-1391
Fax Number	:	916-782-5992

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

Provider Enumeration Date	:	05/24/2005
Last Update Date	:	06/16/2018

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Directions to “ RANDALL A OW ” Practice Location

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