Peterson, Jed Russell

Peterson, Jed Russell is an sole proprietor health care provider with primary practice located at 10123 Se Market St Department Of Radiology, Portland OR 97216-2532. He recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Diagnostic Radiology, Allopathic & Osteopathic Physicians / Vascular & Interventional Radiology. Allopathic & Osteopathic Physicians / Vascular & Interventional Radiology is his primary health care specialty. Peterson, Jed Russell can be contacted via phone (503) 251-6137.

Contact Information

Primary practice address
10123 Se Market St Department Of Radiology Portland OR 97216-2532
Phone: (503) 251-6137
Fax: (503) 261-6058
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Diagnostic Radiology 2085R0202X MD.60212410 Washington
Allopathic & Osteopathic Physicians / Vascular & Interventional Radiology 2085R0204X MD.60212410 Washington
Allopathic & Osteopathic Physicians / Diagnostic Radiology 2085R0202X 157199 Oregon
Allopathic & Osteopathic Physicians / Vascular & Interventional Radiology 2085R0204X 157199 Oregon

Profile Details

NPI number 1164634770
LBN Legal business name Peterson, Jed Russell
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 Yes
Enumeration date May 4th, 2007
Last updated Oct 15th, 2012 - about 14 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1164634770 NPPES
Oregon Other 157199 OREGON MEDICAL BOARD
Oregon Other MD60212410 OREGON MEDICAL BOARD

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