Provider Demographics
NPI:1740267426
Name:BEDDOE, RANDY ALLEN (MD)
Entity type:Individual
Prefix:
First Name:RANDY
Middle Name:ALLEN
Last Name:BEDDOE
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 1:1524 W LACEY BLVD
Mailing Address - Street 2:SUITE 206
Mailing Address - City:HANFORD
Mailing Address - State:CA
Mailing Address - Zip Code:93230-5965
Mailing Address - Country:US
Mailing Address - Phone:559-583-4662
Mailing Address - Fax:559-583-4684
Practice Address - Street 1:1524 W LACEY BLVD
Practice Address - Street 2:SUITE 206
Practice Address - City:HANFORD
Practice Address - State:CA
Practice Address - Zip Code:93230-5965
Practice Address - Country:US
Practice Address - Phone:559-583-4662
Practice Address - Fax:559-583-4684
Is Sole Proprietor?:No
Enumeration Date:2005-12-23
Last Update Date:2013-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG57182207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG57182OtherCALIF. LICENSE
00G571822Medicare PIN
CAA93467Medicare UPIN