MEDICARE: GARY A BURGOINE MD

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	207V00000X	Obstetrics & Gynecology Physician	MD24939	OR
2	207VG0400X	Gynecology Physician	MD24939	OR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1184615304
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GARY A BURGOINE MD

Provider Business Mailing Address
First Line	:	7650 SW BEVELAND RD STE 200
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97223-8692
Country	:	US
Telephone Number	:	503-601-3615
Fax Number	:	503-646-1683

Provider Business Practice Location Address
First Line	:	19250 SW 65TH AVE STE 325
Second Line	:
City	:	TUALATIN
State	:	OR
Zip	:	97062-7452
Country	:	US
Telephone Number	:	503-855-1600
Fax Number	:	503-855-1609

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

Provider Enumeration Date	:	11/04/2005
Last Update Date	:	01/28/2026

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Directions to “ GARY A BURGOINE MD” Practice Location

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