Provider Demographics
NPI:1023122157
Name:VAN JURA, JODI LYNNE (MD)
Entity type:Individual
Prefix:DR
First Name:JODI
Middle Name:LYNNE
Last Name:VAN JURA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4000 MIAMISBURG CENTERVILLE RD STE 410
Mailing Address - Street 2:
Mailing Address - City:MIAMISBURG
Mailing Address - State:OH
Mailing Address - Zip Code:45342-3758
Mailing Address - Country:US
Mailing Address - Phone:937-384-8773
Mailing Address - Fax:937-384-0794
Practice Address - Street 1:4000 MIAMISBURG CENTERVILLE RD
Practice Address - Street 2:SUITE 410
Practice Address - City:MIAMISBURG
Practice Address - State:OH
Practice Address - Zip Code:45342-7615
Practice Address - Country:US
Practice Address - Phone:937-384-8773
Practice Address - Fax:937-384-0794
Is Sole Proprietor?:No
Enumeration Date:2006-08-18
Last Update Date:2022-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35079730207QA0505X
OH35.079730207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2350950Medicaid
OH2350950Medicaid
OHH67651Medicare UPIN
OH4083809Medicare PIN