Healthcare Provider Details

I. General information

NPI: 1295737005
Provider Name (Legal Business Name): RANDY D WATSON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/11/2005
Last Update Date: 10/21/2019
Certification Date:
Deactivation Date: 03/25/2006
Reactivation Date: 04/05/2006

III. Provider practice location address

333 SE 7TH AVE. SUITE 5200
HILLSBORO OR
97123-4182
US

IV. Provider business mailing address

333 SE 7TH AVE. SUITE 5200
HILLSBORO OR
97123-4182
US

V. Phone/Fax

Practice location:
  • Phone: 503-681-4310
  • Fax: 503-681-1989
Mailing address:
  • Phone: 503-681-4310
  • Fax: 503-681-1989

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberMD13719
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: