Provider Demographics
NPI:1205912581
Name:MULLER, ROGER
Entity type:Individual
Prefix:
First Name:ROGER
Middle Name:
Last Name:MULLER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4380 SW MACADAM AVE
Mailing Address - Street 2:SUITE 570
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97239-6403
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:7421 SW BRIDGEPORT RD
Practice Address - Street 2:SUITE 220
Practice Address - City:TIGARD
Practice Address - State:OR
Practice Address - Zip Code:97224-7711
Practice Address - Country:US
Practice Address - Phone:503-684-8252
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD18204207P00000X
WAMD30592207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine