Organization
RANDOLPH E PETERSON
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LESLIE PETERSON (MANAGER)
(541) 889-2899
Entity
Organization
Contact information
Practice address
840 SW 4TH AVENUE, ONTARIO, OR 97914-2627
(541) 889-2899
Mailing address
PO BOX 1460, ONTARIO, OR 97914-1066
(541) 889-2899
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
19969
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
135827
—
OR
Enumeration date
10/24/2007
Last updated
10/24/2007
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