Provider Demographics
NPI:1346349867
Name:LEEFELDT, RANDALL H (MD)
Entity Type:Individual
Prefix:DR
First Name:RANDALL
Middle Name:H
Last Name:LEEFELDT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:10470 OLD PLACERVILLE RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95827-2539
Mailing Address - Country:US
Mailing Address - Phone:800-470-0071
Mailing Address - Fax:
Practice Address - Street 1:475 PIONEER AVE
Practice Address - Street 2:#100
Practice Address - City:WOODLAND
Practice Address - State:CA
Practice Address - Zip Code:95776-4905
Practice Address - Country:US
Practice Address - Phone:530-706-5616
Practice Address - Fax:530-750-7206
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2015-07-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG55710207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G557100Medicaid
F08460Medicare UPIN
00G557101Medicare ID - Type Unspecified