Provider Demographics
NPI:1851484372
Name:RPJURA MEDICAL, PC
Entity Type:Organization
Organization Name:RPJURA MEDICAL, PC
Other - Org Name:RANDELL P JURA, MD, PC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RANDELL
Authorized Official - Middle Name:P
Authorized Official - Last Name:JURA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:503-522-9209
Mailing Address - Street 1:1295 MARKET ST NE
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97301-1371
Mailing Address - Country:US
Mailing Address - Phone:503-522-9209
Mailing Address - Fax:
Practice Address - Street 1:4666 COMMERCIAL ST SE
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97302-1902
Practice Address - Country:US
Practice Address - Phone:503-399-7607
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-02
Last Update Date:2014-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR12431207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR26053-9Medicaid
OR1524OtherWORKERS COMPENSATION OR
ORC94383Medicare UPIN
OR1524OtherWORKERS COMPENSATION OR