Provider Demographics
NPI:1952497802
Name:BOLLINGER, JAN ANDERS (MD)
Entity Type:Individual
Prefix:
First Name:JAN
Middle Name:ANDERS
Last Name:BOLLINGER
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:PO BOX 9220
Mailing Address - Street 2:
Mailing Address - City:TAMUNING
Mailing Address - State:GU
Mailing Address - Zip Code:96931
Mailing Address - Country:US
Mailing Address - Phone:671-646-6610
Mailing Address - Fax:671-649-2266
Practice Address - Street 1:633 GOV CARLOS CAMACHO RD
Practice Address - Street 2:SUITE 212 GUAM MEDICAL PLAZA
Practice Address - City:TAMUNING
Practice Address - State:GU
Practice Address - Zip Code:96913
Practice Address - Country:US
Practice Address - Phone:671-646-6610
Practice Address - Fax:671-649-2266
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GUM00594207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
GU041Medicaid
GU041Medicaid
0000BDGSRMedicare ID - Type Unspecified