Provider Demographics
NPI:1306844683
Name:JONES, DARREN RANDOLPH (MD)
Entity Type:Individual
Prefix:
First Name:DARREN
Middle Name:RANDOLPH
Last Name:JONES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:D RANDOLPH
Other - Middle Name:
Other - Last Name:JONES
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 3158
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97208-3158
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:9427 SW BARNES RD
Practice Address - Street 2:STE 490
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97225-6652
Practice Address - Country:US
Practice Address - Phone:503-216-0770
Practice Address - Fax:503-216-0775
Is Sole Proprietor?:No
Enumeration Date:2005-07-12
Last Update Date:2021-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD25194207RC0000X, 207RC0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0001XAllopathic & Osteopathic PhysiciansInternal MedicineClinical Cardiac Electrophysiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
8400343OtherWA WELFARE
OR022698Medicaid
ORP00865972OtherRR MEDICARE
R155305Medicare PIN
ORR155305Medicare PIN
I09171Medicare UPIN
R169249Medicare PIN
R119661Medicare PIN
OR022698Medicaid
R133770Medicare PIN
ORP00865972OtherRR MEDICARE
ORR161339Medicare PIN