# RANDY D VISSER DO PC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1720498389
- **Authorized official:** DR. RANDY DALE VISSER (OWNER)
- **Authorized official phone:** (541) 420-9482

## Contact information

- **Practice address:** 4282 SW 43RD ST, REDMOND, OR 97756-6976
- **Practice address phone:** (541) 420-9482
- **Practice address fax:** (541) 323-3794
- **Mailing address:** PO BOX 520, REDMOND, OR 97756-0111
- **Mailing address phone:** (541) 420-9482
- **Mailing address fax:** (541) 323-3794

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207R00000X | Internal Medicine Physician | 18333 | OR | Yes |

## Other

- **Enumeration date:** 05/05/2014
- **Last updated:** 12/29/2020