Provider Demographics
NPI:1306006457
Name:LA ROCHELLE, JEFFREY CHRISTOPHER (MD)
Entity type:Individual
Prefix:
First Name:JEFFREY
Middle Name:CHRISTOPHER
Last Name:LA ROCHELLE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2725 NE 23RD AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97212-3414
Mailing Address - Country:US
Mailing Address - Phone:503-724-6934
Mailing Address - Fax:
Practice Address - Street 1:600 NW 11TH ST
Practice Address - Street 2:
Practice Address - City:HERMISTON
Practice Address - State:OR
Practice Address - Zip Code:97838-8605
Practice Address - Country:US
Practice Address - Phone:541-567-5305
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-12
Last Update Date:2024-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD126296208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0A1002960Medicaid
CAAY776Medicare PIN