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Individual

DR. RANDALL W JENNINGS

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
1900 WOODLAND DR, COOS BAY, OR 97420-2045
(541) 267-5151
(541) 266-4515
Mailing address
1900 WOODLAND DR, COOS BAY, OR 97420-2045
(541) 267-5151
(541) 266-4515

Taxonomy

Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
036105293
IL
207X00000X
Orthopaedic Surgery Physician
Primary
MD166994
OR
207XX0005X
Sports Medicine (Orthopaedic Surgery) Physician
43003-020
WI
207XX0005X
Sports Medicine (Orthopaedic Surgery) Physician
L09261R
LA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
005530345
MEDICARE ID, UNSPECIFIED
WI
01
1407812365
GROUP NPI NORTH BEND MEDICAL CENTER
OR
01
161133
GROUP MEDICAID NORTH BEND MEDICAL CENTER
OR
05
500677744
OR
01
P01434156
RAILROAD MEDICARE
OR
01
R0000WFBTV
GROUP MEDICARE NORTH BEND MEDICAL CENTER
OR
Enumeration date
09/30/2005
Last updated
03/24/2026
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