Provider Demographics
NPI:1679672406
Name:MCCAFFERTY, RANDALL ROBERT (MD)
Entity Type:Individual
Prefix:
First Name:RANDALL
Middle Name:ROBERT
Last Name:MCCAFFERTY
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 1:1180 N INDIAN CANYON DR STE E205
Mailing Address - Street 2:
Mailing Address - City:PALM SPRINGS
Mailing Address - State:CA
Mailing Address - Zip Code:92262-4876
Mailing Address - Country:US
Mailing Address - Phone:760-325-1202
Mailing Address - Fax:760-864-7105
Practice Address - Street 1:1180 N INDIAN CANYON DR STE E205
Practice Address - Street 2:
Practice Address - City:PALM SPRINGS
Practice Address - State:CA
Practice Address - Zip Code:92262-4876
Practice Address - Country:US
Practice Address - Phone:760-325-1202
Practice Address - Fax:760-864-7105
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2019-05-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXM5365207T00000X
OH35-079331207T00000X
CAGFE 81608207T00000X
CAG81608207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery