Provider Demographics
NPI:1144244062
Name:MCCOLGIN, GENE (MD)
Entity Type:Individual
Prefix:DR
First Name:GENE
Middle Name:
Last Name:MCCOLGIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1605 BLACK SANDS WAY
Mailing Address - Street 2:
Mailing Address - City:TILLAMOOK
Mailing Address - State:OR
Mailing Address - Zip Code:97141-8386
Mailing Address - Country:US
Mailing Address - Phone:503-842-8502
Mailing Address - Fax:503-842-8504
Practice Address - Street 1:1000 3RD ST
Practice Address - Street 2:
Practice Address - City:TILLAMOOK
Practice Address - State:OR
Practice Address - Zip Code:97141-3430
Practice Address - Country:US
Practice Address - Phone:503-842-4444
Practice Address - Fax:503-815-2305
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2007-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD20783207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR999999Medicaid
OR108741Medicare UPIN
ORE43216Medicare ID - Type Unspecified