Provider Demographics
NPI:1033126339
Name:BOLLINGER, GREGORY (LMT)
Entity Type:Individual
Prefix:MR
First Name:GREGORY
Middle Name:
Last Name:BOLLINGER
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:294 WARNER MILNE RD
Mailing Address - Street 2:
Mailing Address - City:OREGON CITY
Mailing Address - State:OR
Mailing Address - Zip Code:97045-4288
Mailing Address - Country:US
Mailing Address - Phone:503-974-9628
Mailing Address - Fax:503-974-9642
Practice Address - Street 1:294 WARNER MILNE RD
Practice Address - Street 2:
Practice Address - City:OREGON CITY
Practice Address - State:OR
Practice Address - Zip Code:97045-4288
Practice Address - Country:US
Practice Address - Phone:503-974-9628
Practice Address - Fax:503-974-9642
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-01
Last Update Date:2012-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORLMT12298208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation