Jed Russell Peterson in Portland - Diagnostic Radiology
Jed Russell Peterson - NPI 1164634770
Jed Russell Peterson is a Diagnostic Radiology in Portland, Oregon. Jed Russell Peterson practices all healthcare services and medical treatments related to Diagnostic Radiology. The NPI Number for Jed Russell Peterson is 1164634770. The last update date is 2012-10-15.
Jed Russell Peterson's current location address is 10123 Se Market St, Portland, Oregon. You can contact this provider via phone number 5032516137 and fax number 5032616058. The mailing address for Jed Russell Peterson is 10123 Se Market St, Portland, Oregon. To know further, please read the information below!
Provider Profile Detail
| Provider Name | Jed Russell Peterson |
|---|---|
| Address | 10123 Se Market St, Portland, Oregon |
| Phone Number | 5032516137 |
| Fax Number | 5032616058 |
| Sole Proprietor | Y |
| Credentials | M.D. |
NPI Number Detail
| NPI Number | 1164634770 |
|---|---|
| Provider Enumeration Date | 2007-05-04 |
| Last Updated Date | 2012-10-15 |
Provider Mailing Address Detail
| Address | 10123 Se Market St |
|---|---|
| City | Portland |
| State | Oregon (OR) |
| Post Code | 972162532 |
| Phone Number | 5032516137 |
| Fax Number | 5032616058 |
Provider's Primary Taxonomy Detail
| Speciality | Diagnostic Radiology |
|---|---|
| Taxonomy | 2085R0202X |
| Licence No | MD.60212410 |
|
Definition: A radiologist who utilizes x-ray, radionuclides, ultrasound and electromagnetic radiation to diagnose and treat disease. |
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Provider's Other Legacy Identifiers
| Identifier | Identifier Type | Identifier State | Identifier Issuer |
|---|---|---|---|
| 157199 | OR | OREGON MEDICAL BOARD | |
| MD60212410 | WA | MEDICAL LICENSE NUMBER |
Post Comment/ Review Below
What is the unique identifier code issued to Jed Russell Peterson by the Centers for Medicare & Medicaid Services (CMS)?
The Jed Russell Peterson has been assigned the NPI (National Provider Identifier) 1164634770. This 10-digit code serves as a unique identification number for healthcare providers, issued by the CMS.
Could you please provide the complete street address where Jed Russell Peterson is physically located?
The Jed Russell Peterson is physically situated at the following address: 10123 Se Market St, Portland, OR, 972162532.
What is Jed Russell Peterson's primary area of medical expertise, and what taxonomy classification code corresponds to this specialized field?
The primary area of medical expertise for Jed Russell Peterson is Diagnostic Radiology, and the corresponding taxonomy classification code for this specialized field is 2085R0202X.
On what date did Jed Russell Peterson receive its 1164634770 assignment from the Centers for Medicare & Medicaid Services?
The Jed Russell Peterson was assigned its 1164634770 on 2007-05-04, which is the date when this unique identifier was issued to the organization by the Centers for Medicare & Medicaid Services.
As of what date were the details related to Jed Russell Peterson most recently updated or revised?
The information pertaining to Jed Russell Peterson, including its address, specialty, and other relevant details, was last updated or revised on 2012-10-15.