MEDICARE: MR. GREGORY BOLLINGER LMT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208100000X	Physical Medicine & Rehabilitation Physician	LMT12298	OR

General Provider Information

NPI Number	:	1033126339
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. GREGORY BOLLINGER LMT

Provider Business Mailing Address
First Line	:	294 WARNER MILNE RD
Second Line	:
City	:	OREGON CITY
State	:	OR
Zip	:	97045-4288
Country	:	US
Telephone Number	:	503-974-9628
Fax Number	:	503-974-9642

Provider Business Practice Location Address
First Line	:	294 WARNER MILNE RD
Second Line	:
City	:	OREGON CITY
State	:	OR
Zip	:	97045-4288
Country	:	US
Telephone Number	:	503-974-9628
Fax Number	:	503-974-9642

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/01/2006
Last Update Date	:	08/28/2012

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