Individual
DR. RANDY J KJORSTAD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1315 NW 4TH ST STE A, REDMOND, OR 97756-1328
(541) 548-7761
(541) 598-3485
Mailing address
PO BOX 428, JACKSON, WY 83001-0428
(307) 739-7690
(307) 739-7644
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
12855
MT
208600000X
Surgery Physician
Primary
9756A
WY
208600000X
Surgery Physician
M-9325
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
W26189
SJMC PTAN
WY
Enumeration date
02/08/2006
Last updated
10/17/2025
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