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 1:3303 SW BOND AVE
Mailing Address - Street 2:CH10U
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97239-4501
Mailing Address - Country:US
Mailing Address - Phone:503-346-1500
Mailing Address - Fax:503-346-1501
Practice Address - Street 1:3303 SW BOND AVE
Practice Address - Street 2:CH10U
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97239-4501
Practice Address - Country:US
Practice Address - Phone:503-346-1500
Practice Address - Fax:503-346-1501
Is Sole Proprietor?:No
Enumeration Date:2008-06-12
Last Update Date:2009-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR126296208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0A1002960Medicaid
CAAY776Medicare PIN