Healthcare Provider Details

I. General information

NPI: 1720308620
Provider Name (Legal Business Name): ARUNA JAYARAM M.D
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/03/2010
Last Update Date: 05/02/2025
Certification Date: 05/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1813 W HARVARD AVE SUITE 201
ROSEBURG OR
97471-2752
US

IV. Provider business mailing address

PO BOX 2077
PORTLAND OR
97208-2077
US

V. Phone/Fax

Practice location:
  • Phone: 541-440-6390
  • Fax: 541-440-6392
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD151031
License Number StateOR
# 3
Primary TaxonomyN
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License NumberMD61682189
License Number StateWA
# 4
Primary TaxonomyY
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License NumberMD151031
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: