Provider Demographics
NPI:1679569933
Name:WOESNER, RANDALL E (MD)
Entity Type:Individual
Prefix:DR
First Name:RANDALL
Middle Name:E
Last Name:WOESNER
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 1:248-A HOSPITAL DR
Mailing Address - Street 2:
Mailing Address - City:UKIAH
Mailing Address - State:CA
Mailing Address - Zip Code:95482-4555
Mailing Address - Country:US
Mailing Address - Phone:707-463-1659
Mailing Address - Fax:707-463-2195
Practice Address - Street 1:248-A HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:UKIAH
Practice Address - State:CA
Practice Address - Zip Code:95482-4555
Practice Address - Country:US
Practice Address - Phone:707-463-1659
Practice Address - Fax:707-463-2195
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-22
Last Update Date:2008-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG44111207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G441110Medicaid
A49555Medicare UPIN
00G441111Medicare PIN