Provider Demographics
NPI:1295737005
Name:WATSON, RANDY D (MD)
Entity type:Individual
Prefix:
First Name:RANDY
Middle Name:D
Last Name:WATSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:333 SE 7TH AVE.
Mailing Address - Street 2:SUITE 5200
Mailing Address - City:HILLSBORO
Mailing Address - State:OR
Mailing Address - Zip Code:97123-4182
Mailing Address - Country:US
Mailing Address - Phone:503-681-4310
Mailing Address - Fax:503-681-1989
Practice Address - Street 1:333 SE 7TH AVE.
Practice Address - Street 2:SUITE 5200
Practice Address - City:HILLSBORO
Practice Address - State:OR
Practice Address - Zip Code:97123-4182
Practice Address - Country:US
Practice Address - Phone:503-681-4310
Practice Address - Fax:503-681-1989
Is Sole Proprietor?:No
Enumeration Date:2005-08-11
Last Update Date:2019-10-21
Deactivation Date:2006-03-25
Deactivation Code:
Reactivation Date:2006-04-05
Provider Licenses
StateLicense IDTaxonomies
ORMD13719207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR071092Medicaid
OR071092Medicaid
00WCKJBCMedicare ID - Type Unspecified