Individual
DR. RANDALL D GORE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
9290 SE SUNNYBROOK BLVD, SUITE 120, CLACKAMAS, OR 97015-6899
(503) 215-2110
Mailing address
PO BOX 3158, PORTLAND, OR 97208-3158
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
MD08210
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
111913558
PALMETTO GBA
OR
05
—
231167
—
OR
Enumeration date
09/07/2005
Last updated
02/12/2013
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