IndividualActive
Jeffrey Koller, PA-C
NPI 1215790639 · Physician Assistant · Sublimity, OR
Provider details
- NPI number
- 1215790639
- Entity type
- Individual
- Primary specialty
- Physician AssistantPhysician Assistants & Advanced Practice Nursing Providers
- Credential
- PA-C
- Sex
- Male
- Sole proprietor
- No
- License
- PA218511 (OR)
Specialties & taxonomies
Physician Assistants & Advanced Practice Nursing Providers
Practice location
114 Se Church St
Sublimity, OR 97385-9424
Phone: (503) 769-2259
Approximate (ZIP-level) locationGet directions
Mailing address
114 Se Church St
Sublimity, OR 97385-9424
Registry dates
- Enumerated
- 2024-01-31
- Last updated
- 2025-12-22
- Certified
- 2025-12-22
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.