Healthcare Provider Details

I. General information

NPI: 1891943825
Provider Name (Legal Business Name): MICHAEL JACOB LOEFFLER PHYSICIAN ASSISTANT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/03/2008
Last Update Date: 05/29/2025
Certification Date: 05/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15022 MAYBOB RD.
NINE MILE FALLS WA
99026-8639
US

IV. Provider business mailing address

15022 W MAYBOB RD
NINE MILE FALLS WA
99026-8639
US

V. Phone/Fax

Practice location:
  • Phone: 509-270-2135
  • Fax:
Mailing address:
  • Phone: 509-270-2135
  • Fax: 509-270-2135

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1710I1002X
TaxonomyIndependent Duty Corpsman
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: