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Individual

JAMIE LEE RANDLES

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
MD

Contact information

Practice address
4920 N INTERSTATE AVE, PORTLAND, OR 97217-3653
(503) 215-3300
Mailing address
PO BOX 3158, PORTLAND, OR 97208-3158

Taxonomy

Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
0420012472
VT
207Q00000X
Family Medicine Physician
LL18409
OR
207Q00000X
Family Medicine Physician
Primary
MD172570
OR

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
1020869
VT
05
500689118
OR
Enumeration date
06/08/2009
Last updated
03/24/2021
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