Individual
RANDELL PETER JURA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
10915 SE STARK ST, PORTLAND, OR 97216-3348
(503) 261-1120
(503) 261-8936
Mailing address
10915 SE STARK ST, PORTLAND, OR 97216-3348
(503) 261-1120
(503) 261-8936
Taxonomy
Speciality
Code
Description
License number
State
207QA0505X
Adult Medicine Physician
Primary
12431
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0000BHPBD
OREGON WORKERS COMP
OR
05
—
26053-9
—
OR
Enumeration date
05/11/2016
Last updated
07/21/2023
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