Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Jackson Randolph, MD

Individual provider Otolaryngology Physician · NPI 1063040970

Jackson Randolph, MD is an Otolaryngology in San Luis Obispo, California. Qualified in 2020, 6 years ago. Practices with Adventist Health Physicians Network, a 632-clinician group and accepts Medicare assignment. Licensed in California.

Years since qualifying
6
Licensed in
CA
In the registry since
2020
What do these letters mean?
MD — Doctor of Medicine
A physician who completed allopathic medical school.

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Practice location Address checks out

35 Casa St Ste 130
San Luis Obispo, CA 93405-1887
Phone: (805) 541-1422
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Otolaryngology Physician (primary) Taxonomy 207Y00000X · Licence A202960 (CA)

Record details

NPI number1063040970
Entity typeIndividual (Type 1)
GenderMale
Credentials MD
Sole proprietorYes
NPI enumeratedMarch 28, 2020
Last updated in NPPESJune 14, 2025
Certification dateJune 14, 2025

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyOTOLARYNGOLOGY
Medical schoolOTHER
Graduated 2020 (6 years in practice)
Group practice Adventist Health Physicians Network — 632 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
Practice locations3 on file with Medicare

Other providers in San Luis Obispo