Provider Demographics
NPI:1407965171
Name:WHINNERY, RANDOLPH D (MD)
Entity Type:Individual
Prefix:
First Name:RANDOLPH
Middle Name:D
Last Name:WHINNERY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:771 BUSCHMANN RD
Mailing Address - Street 2:SUITE N
Mailing Address - City:PARADISE
Mailing Address - State:CA
Mailing Address - Zip Code:95969-5848
Mailing Address - Country:US
Mailing Address - Phone:530-877-0230
Mailing Address - Fax:530-877-0237
Practice Address - Street 1:771 BUSCHMANN RD
Practice Address - Street 2:SUITE N
Practice Address - City:PARADISE
Practice Address - State:CA
Practice Address - Zip Code:95969-5848
Practice Address - Country:US
Practice Address - Phone:530-877-0230
Practice Address - Fax:530-877-0237
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA42984207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A429840Medicaid
CAE36422Medicare UPIN
CA00A429840Medicaid