Provider Demographics
NPI:1427568823
Name:SHOFFER, JOHN ERIC (PA-C)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:ERIC
Last Name:SHOFFER
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3485 S BOND AVE BLDG 2
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97239-4503
Mailing Address - Country:US
Mailing Address - Phone:503-494-1100
Mailing Address - Fax:503-494-1110
Practice Address - Street 1:3485 S BOND AVE BLDG 2
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97239-4503
Practice Address - Country:US
Practice Address - Phone:503-494-1100
Practice Address - Fax:503-494-1110
Is Sole Proprietor?:No
Enumeration Date:2017-10-11
Last Update Date:2023-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH50.005323RX363A00000X
ORPA201780363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant