Individual
RANDALL E BLOME
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
9605 GRAND RONDE RD, GRAND RONDE, OR 97347-9712
(503) 879-2002
(503) 879-2015
Mailing address
9605 GRAND RONDE RD, GRAND RONDE, OR 97347-9712
(503) 879-2002
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
MD17595
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0200572
WA LABOR & INDUSTRIES
WA
05
—
034558
—
OR
Enumeration date
04/18/2006
Last updated
10/16/2024
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