Basic Information
| Provider Information | |||||||||
| NPI: | 1992861454 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SILTANEN | ||||||||
| FirstName: | RANDY | ||||||||
| MiddleName: | ANTON | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 18858 | ||||||||
| Address2: | |||||||||
| City: | RENO | ||||||||
| State: | NV | ||||||||
| PostalCode: | 895110188 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7752833315 | ||||||||
| FaxNumber: | 7756249763 | ||||||||
| Practice Location | |||||||||
| Address1: | 900 SUNSET DR | ||||||||
| Address2: | |||||||||
| City: | LA GRANDE | ||||||||
| State: | OR | ||||||||
| PostalCode: | 978501362 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5419638421 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 12/29/2006 | ||||||||
| LastUpdateDate: | 02/27/2017 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0202X | MD20408 | OR | Y | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
ID Information
| ID | Type | State | Issuer | Description | 041077003 | 01 | OR | REGENCE BLUE CROSS | OTHER | 300128864 | 01 | OR | RAILROAD MEDICARE | OTHER | 130116 | 01 | OR | WASHINGTON LABOR & IND | OTHER | 7097231 | 05 | WA | MEDICAID | 150375 | 05 | OR | MEDICAID |