Healthcare Provider Details

I. General information

NPI: 1679109532
Provider Name (Legal Business Name): JEFFREY JOHN OURY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/22/2020
Last Update Date: 08/06/2026
Certification Date: 08/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11141 PARKVIEW PLAZA DR STE 305
FORT WAYNE IN
46845-1715
US

IV. Provider business mailing address

1 MEDICAL CENTER DR
MORGANTOWN WV
26506-1200
US

V. Phone/Fax

Practice location:
  • Phone: 260-266-8900
  • Fax: 260-266-8935
Mailing address:
  • Phone: 304-598-0430
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number01095592A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: