Randell Peter Jura, M.D.

Primary specialty

Adult Medicine PhysicianTaxonomy code 207QA0505X

License

12431 Issued in OR

Practice address

10915 SE Stark St
Portland, OR 97216-3348

Phone

(503) 261-1120

Fax

(503) 261-8936

NPI assigned

May 11, 2016

Last updated

Jul 21, 2023By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Medicine

State licenses

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

{
    "created_epoch": "1462924800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1689897600000",
    "number": "1104272921",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10915 SE STARK ST",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972163348",
            "telephone_number": "503-261-1120",
            "fax_number": "503-261-8936"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10915 SE STARK ST",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972163348",
            "telephone_number": "503-261-1120",
            "fax_number": "503-261-8936"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JURA",
        "first_name": "RANDELL",
        "middle_name": "PETER",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2016-05-11",
        "last_updated": "2023-07-21",
        "certification_date": "2023-07-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207QA0505X",
            "taxonomy_group": "",
            "desc": "Family Medicine, Adult Medicine",
            "state": "OR",
            "license": "12431",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "26053-9",
            "state": "OR"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OREGON WORKERS COMP",
            "identifier": "0000BHPBD",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Adult Medicine Physician in Portland, OR
• Providers in Portland, OR by specialty
• Adult Medicine Physician in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2023; 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.