Provider Demographics
NPI:1992745079
Name:STEFFENS, RANDALL L SR (DO)
Entity type:Individual
Prefix:DR
First Name:RANDALL
Middle Name:L
Last Name:STEFFENS
Suffix:SR
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20601 W PAOLI LN
Mailing Address - Street 2:
Mailing Address - City:WEIMAR
Mailing Address - State:CA
Mailing Address - Zip Code:95736-0486
Mailing Address - Country:US
Mailing Address - Phone:615-604-0142
Mailing Address - Fax:
Practice Address - Street 1:20601 W PAOLI LN
Practice Address - Street 2:
Practice Address - City:WEIMAR
Practice Address - State:CA
Practice Address - Zip Code:95736-0486
Practice Address - Country:US
Practice Address - Phone:530-296-4417
Practice Address - Fax:877-425-5508
Is Sole Proprietor?:No
Enumeration Date:2006-06-07
Last Update Date:2014-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1231207P00000X
CA20A9918207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4027864OtherBCBS
TNP00282944OtherRAILROAD MEDICARE
TN3862671Medicaid
TN3862671Medicaid
TN4027864OtherBCBS