Provider Demographics
NPI:1447757885
Name:POLZIN, DENNIS GERE JR (DO)
Entity Type:Individual
Prefix:
First Name:DENNIS
Middle Name:GERE
Last Name:POLZIN
Suffix:JR
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:36429 ROW RIVER RD
Mailing Address - Street 2:
Mailing Address - City:COTTAGE GROVE
Mailing Address - State:OR
Mailing Address - Zip Code:97424-9424
Mailing Address - Country:US
Mailing Address - Phone:262-235-2608
Mailing Address - Fax:
Practice Address - Street 1:36429 ROW RIVER RD
Practice Address - Street 2:
Practice Address - City:COTTAGE GROVE
Practice Address - State:OR
Practice Address - Zip Code:97424-9424
Practice Address - Country:US
Practice Address - Phone:262-235-2608
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-11
Last Update Date:2021-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ009205207Q00000X
WAOP61031952207Q00000X
ORDO197631207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine