Frederick M Bolzendahl, PA-C
Individual provider Active NPI Physician Assistant · Portland, OR
NPI 1992801252 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1992801252
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physician Assistant 363A00000X
- License
- PA00507 (OR)
- Practice address
- 3710 SW US Veterans Rd
Portland, OR 97207 - Phone
- (503) 220-8262
- NPI assigned
- Sep 15, 2006
- Sex
- Male
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PA00507 | OR | MD | Physician Assistant |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | PA00507 | OR | Yes |
Addresses
Primary practice location
3710 SW US Veterans Rd
Portland, OR 97207
Mailing address
15515 NE 25TH Ave
Vancouver, WA 98686
Phone (360) 571-9416
Other providers in Portland, OR
- Vicki K Bolton
- Danielle Boltz
- Jacqueline Elizabeth Boltz
- Boly Health and Education, LLC
- Hilarey Boly
- Janelle M Bombara
- Despoina Bompolaki
- Bon Vivant Health and Wellness, LLC
- Catharine Ann Bon
- Maria Therese Bonacci
All providers in Portland, OR · Physician Assistant in Oregon
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.