Provider Demographics
NPI:1336142215
Name:HEPWORTH, RANDALL CLAUD (MD)
Entity Type:Individual
Prefix:DR
First Name:RANDALL
Middle Name:CLAUD
Last Name:HEPWORTH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:4752 KATHYWOOD CT
Mailing Address - Street 2:
Mailing Address - City:FAIR OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:95628-6015
Mailing Address - Country:US
Mailing Address - Phone:916-967-8311
Mailing Address - Fax:916-965-6324
Practice Address - Street 1:1000 RIVER ROCK DR
Practice Address - Street 2:STE 114
Practice Address - City:FOLSOM
Practice Address - State:CA
Practice Address - Zip Code:95630-2093
Practice Address - Country:US
Practice Address - Phone:916-989-2086
Practice Address - Fax:916-989-0367
Is Sole Proprietor?:Yes
Enumeration Date:2005-05-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA00G045570208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA50095Medicare UPIN