Active NPI
James Bruce Eubanks Sr., D.O.
- Family Medicine Physician
- Troutdale, OR
National Provider Identifier
1174637607
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- DO16596
- Practice address
- 2800 SW 257TH Ave
Troutdale, OR 97060-1803 - Phone
- (503) 667-7711
- Fax
- (503) 669-8328
- NPI assigned
- Aug 19, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | DO16596 | OR | Primary |
Addresses
Primary practice location
2800 SW 257TH Ave
Troutdale, OR 97060-1803
Mailing address
2800 SW 257TH Ave
Troutdale, OR 97060-1803
Phone (503) 667-7711
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 031067 | Medicaid | OR |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Osteopathy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 16596 | OR | MD | Community Health Worker |
| DO16596 | OR | MD | Family Medicine Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1155945600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1380585600000",
"number": "1174637607",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2800 SW 257TH AVE",
"city": "TROUTDALE",
"state": "OR",
"postal_code": "970601803",
"telephone_number": "503-667-7711",
"fax_number": "503-669-8328"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2800 SW 257TH AVE",
"city": "TROUTDALE",
"state": "OR",
"postal_code": "970601803",
"telephone_number": "503-667-7711",
"fax_number": "503-669-8328"
}
],
"practiceLocations": [],
"basic": {
"last_name": "EUBANKS",
"first_name": "JAMES",
"middle_name": "BRUCE",
"name_suffix": "Sr.",
"credential": "D.O.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-08-19",
"last_updated": "2013-10-01",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "OR",
"license": "DO16596",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "031067",
"state": "OR"
}
],
"endpoints": [],
"other_names": []
}Other providers in Troutdale, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 1, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.