Provider Demographics
NPI:1013007889
Name:CONTRA COSTA ENT MEDICAL ASSOC
Entity Type:Organization
Organization Name:CONTRA COSTA ENT MEDICAL ASSOC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:RANDALL
Authorized Official - Middle Name:K
Authorized Official - Last Name:WENOKUR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:825-685-7400
Mailing Address - Street 1:2700 GRANT STREET
Mailing Address - Street 2:SUITE 104
Mailing Address - City:CONCORD
Mailing Address - State:CA
Mailing Address - Zip Code:94520
Mailing Address - Country:US
Mailing Address - Phone:925-685-7400
Mailing Address - Fax:925-685-0917
Practice Address - Street 1:2700 GRANT ST
Practice Address - Street 2:SUITE 104
Practice Address - City:CONCORD
Practice Address - State:CA
Practice Address - Zip Code:94520
Practice Address - Country:US
Practice Address - Phone:925-685-7400
Practice Address - Fax:925-685-0917
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-13
Last Update Date:2011-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty