Bullock, Gina M

Bullock, Gina M is an individual health care provider with primary practice located at 3508 Ne Broadway St , Portland OR 97232-1821. She recently has only one registered license in Podiatric Medicine & Surgery Service Providers / Foot & Ankle Surgery, which is considered as her primary health care specialty. Bullock, Gina M can be contacted via phone (503) 282-8777.

Contact Information

Primary practice address
3508 Ne Broadway St Portland OR 97232-1821
Phone: (503) 282-8777
Fax: (503) 282-8853
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Podiatric Medicine & Surgery Service Providers / Foot & Ankle Surgery 213ES0103X DP00244 Oregon

Profile Details

NPI number 1255440020
LBN Legal business name Bullock, Gina M
Credentials Doctor of Podiatric Medicine (DPM)
Entity Individual
Sole proprietor 1 No
Enumeration date Aug 29th, 2006
Last updated Mar 7th, 2023 - about last year

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1255440020 NPPES
Oregon MEDICAID 083431

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