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MR. RANDALL THOMAS STEWART

Active
Sole proprietor

Provider details

NPI number
Gender
Man
Credential
CRNA

Contact information

Practice address
1700 E 19TH ST, MID COLUMBIA MEDICAL CENTER, THE DALLES, OR 97058-9653
(541) 296-1111
(541) 296-7614
Mailing address
4280 PLEASANT RIDGE RD, THE DALLES, OR 97058-9653
(541) 296-9614

Taxonomy

Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
AP30004725
WA
367500000X
Certified Registered Nurse Anesthetist
RN0006617
WA
367500000X
Certified Registered Nurse Anesthetist
Primary
OR

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
0035006
WA DEPT LABOR
WA
05
071290
OR
01
08263900O
BCBS
OR
05
9025966
WA
Enumeration date
01/06/2006
Last updated
07/08/2007
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