Provider Demographics
NPI:1205915691
Name:OHLING, DIRK ANTHONY (MD)
Entity type:Individual
Prefix:DR
First Name:DIRK
Middle Name:ANTHONY
Last Name:OHLING
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 1:2605 WILLETTA ST SW
Mailing Address - Street 2:SUITE D-1
Mailing Address - City:ALBANY
Mailing Address - State:OR
Mailing Address - Zip Code:97321-3408
Mailing Address - Country:US
Mailing Address - Phone:541-924-2873
Mailing Address - Fax:
Practice Address - Street 1:2605 WILLETTA ST SW
Practice Address - Street 2:SUITE D-1
Practice Address - City:ALBANY
Practice Address - State:OR
Practice Address - Zip Code:97321-3408
Practice Address - Country:US
Practice Address - Phone:541-924-2873
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD21054207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR15120-4Medicaid
OR15120-4Medicaid
ORR101383Medicare ID - Type Unspecified