Individual
DAVID MARTIN KOELLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
3181 SW SAM JACKSON PARK RD, PORTLAND, OR 97239-3011
(503) 494-7859
Mailing address
707 SW GAINES ST, METABOLIC CLINIC, CDRC-P, PORTLAND, OR 97239-2901
Taxonomy
Speciality
Code
Description
License number
State
207SG0202X
Clinical Biochemical Genetics Physician
Primary
MD22656
OR
208000000X
Pediatrics Physician
MD22656
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
287980
—
OR
Enumeration date
08/03/2006
Last updated
07/11/2007
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