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Individual
JEFFERY KOLK HERBERT
Active
Individual
JEFFERY KOLK HERBERT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
P.A.
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
PA00572
OR
363AM0700X
Medical Physician Assistant
PA00572
OR
363AS0400X
Surgical Physician Assistant
Primary
PA00572
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
064456
—
OR
01
—
4898008
BLUE CROSS
OR
Enumeration date
10/17/2006
Last updated
09/11/2025
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