Gore, Randall D
Gore, Randall D is an sole proprietor health care provider with primary practice located at 9290 Se Sunnybrook Blvd Suite 120, Clackamas OR 97015-6899. He recently has only one registered license in Allopathic & Osteopathic Physicians / Internal Medicine, which is considered as his primary health care specialty. Gore, Randall D can be contacted via phone (503) 215-2110.Contact Information
Primary practice address
9290 Se Sunnybrook Blvd Suite 120
Clackamas OR 97015-6899
Phone: (503) 215-2110
Fax:
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Internal Medicine | 207R00000X | MD08210 | Oregon |
Profile Details
| NPI number | 1639163447 |
|---|---|
| LBN Legal business name | Gore, Randall D |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | Yes |
| Enumeration date | Sep 7th, 2005 |
| Last updated | Feb 12th, 2013 - about 11 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.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1639163447 | NPPES |
| Oregon | Other | 111913558 | PALMETTO GBA |
| Oregon | MEDICAID | 231167 | PALMETTO GBA |
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