NPIMap

Organization Active NPI

Randy D Visser DO PC

  • Internal Medicine Physician
  • Redmond, OR
National Provider Identifier
1720498389
Registry record updated Dec 29, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
18333 Issued in OR
Legal business name
RANDY D VISSER DO PC
Practice address
4282 SW 43Rd St
Redmond, OR 97756-6976
Phone
(541) 420-9482
Fax
(541) 323-3794
NPI assigned
May 5, 2014
Last updated
Dec 29, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 29, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Randy Dale VisserNPI 1801859574
Title
Owner
Phone
(541) 420-9482

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 18333 OR Primary

Addresses

Primary practice location

4282 SW 43Rd St
Redmond, OR 97756-6976

Mailing address

PO Box 520
Redmond, OR 97756-0111
Phone (541) 420-9482

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1399248000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1609200000000",
    "number": "1720498389",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 520",
            "city": "REDMOND",
            "state": "OR",
            "postal_code": "977560111",
            "telephone_number": "541-420-9482",
            "fax_number": "541-323-3794"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4282 SW 43RD ST",
            "city": "REDMOND",
            "state": "OR",
            "postal_code": "977566976",
            "telephone_number": "541-420-9482",
            "fax_number": "541-323-3794"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RANDY D VISSER DO PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-05-05",
        "last_updated": "2020-12-29",
        "certification_date": "2020-12-29",
        "status": "A",
        "authorized_official_last_name": "VISSER",
        "authorized_official_first_name": "RANDY",
        "authorized_official_middle_name": "DALE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "541-420-9482",
        "authorized_official_name_prefix": "Dr."
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "OR",
            "license": "18333",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Redmond, OR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 29, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.