Organization
DIAGNOSTIC RADIOLOGISTS PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JED RUSSELL PETERSON MD (PRESIDENT)
(503) 251-6132
Entity
Organization
Contact information
Practice address
10123 SE MARKET, PORTLAND, OR 97216
(503) 251-6132
(503) 251-6136
Mailing address
PO BOX 16961, PORTLAND, OR 97292-0961
(035) 251-6855
(503) 251-6136
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
064972
—
OR
05
—
7805609
—
WA
05
—
H110076
—
HI
Enumeration date
05/28/2006
Last updated
10/29/2024
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