Provider Demographics
NPI:1114093853
Name:CHAPMAN, RANDALL H (MD)
Entity Type:Individual
Prefix:
First Name:RANDALL
Middle Name:H
Last Name:CHAPMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1615 HILL RD
Mailing Address - Street 2:SUITE 8
Mailing Address - City:NOVATO
Mailing Address - State:CA
Mailing Address - Zip Code:94947
Mailing Address - Country:US
Mailing Address - Phone:415-897-1022
Mailing Address - Fax:415-897-7272
Practice Address - Street 1:1615 HILL RD
Practice Address - Street 2:SUITE 8
Practice Address - City:NOVATO
Practice Address - State:CA
Practice Address - Zip Code:94947
Practice Address - Country:US
Practice Address - Phone:415-897-1022
Practice Address - Fax:415-897-7272
Is Sole Proprietor?:No
Enumeration Date:2006-11-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA00A294500207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A294500Medicaid
CA00A294500Medicaid
A25773Medicare UPIN