Provider Demographics
NPI:1891943825
Name:LOEFFLER, MICHAEL JACOB (PHYSICIAN ASSISTANT)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:JACOB
Last Name:LOEFFLER
Suffix:
Gender:M
Credentials:PHYSICIAN ASSISTANT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15022 W MAYBOB RD
Mailing Address - Street 2:
Mailing Address - City:NINE MILE FALLS
Mailing Address - State:WA
Mailing Address - Zip Code:99026-8639
Mailing Address - Country:US
Mailing Address - Phone:509-270-2135
Mailing Address - Fax:509-270-2135
Practice Address - Street 1:15022 MAYBOB RD.
Practice Address - Street 2:
Practice Address - City:NINE MILE FALLS
Practice Address - State:WA
Practice Address - Zip Code:99026-8639
Practice Address - Country:US
Practice Address - Phone:509-270-2135
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-09-03
Last Update Date:2024-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman