Healthcare Provider Details

I. General information

NPI: 1205912581
Provider Name (Legal Business Name): ROGER MULLER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/28/2006
Last Update Date: 12/07/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7421 SW BRIDGEPORT RD SUITE 220
TIGARD OR
97224-7711
US

IV. Provider business mailing address

4380 SW MACADAM AVE SUITE 570
PORTLAND OR
97239-6403
US

V. Phone/Fax

Practice location:
  • Phone: 503-684-8252
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberMD18204
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberMD30592
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: