Organization
DIAGNOSTIC RADIOLOGISTS, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JED RUSSELL PETERSON MD (PRESIDENT)
(503) 251-6132
Entity
Organization
Contact information
Practice address
10123 SE MARKET ST, PORTLAND, OR 97216-2532
(503) 251-6132
Mailing address
PO BOX 2097, PORTLAND, OR 97208-2097
(503) 251-6132
(503) 251-6236
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
H110076
—
HI
Enumeration date
03/26/2007
Last updated
05/20/2019
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