Individual
JEFFREY P PAVELKA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
16180 SE SUNNYSIDE RD, SUITE 102, HAPPY VALLEY, OR 97015-6302
(503) 582-4900
Mailing address
PO BOX 3158, PORTLAND, OR 97208-3158
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
DO-757
AL
207Q00000X
Family Medicine Physician
DO28819
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
051510830
BCBS
AL
05
—
500601728
—
OR
Enumeration date
05/02/2006
Last updated
03/24/2021
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