MEDICARE: MARK BOLLMAN M.D.

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	2080H0002X	Pediatric Hospice and Palliative Medicine Physician	R3478	TX

General Provider Information

NPI Number	:	1164841219
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARK BOLLMAN M.D.

Provider Business Mailing Address
First Line	:	1015 NW 22ND AVE
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97210-3025
Country	:	US
Telephone Number	:	503-413-3900
Fax Number	:	503-413-3710

Provider Business Practice Location Address
First Line	:	1015 NW 22ND AVE
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97210-3025
Country	:	US
Telephone Number	:	503-220-1000
Fax Number	:

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

Provider Enumeration Date	:	04/15/2014
Last Update Date	:	09/13/2018

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