Individual
GINA M BULLOCK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DPM
Contact information
Practice address
3508 NE BROADWAY ST, PORTLAND, OR 97232-1821
(503) 282-8777
(503) 282-8853
Mailing address
3508 NE BROADWAY ST, PORTLAND, OR 97232-1821
(503) 282-8777
(503) 282-8853
Taxonomy
Speciality
Code
Description
License number
State
213ES0103X
Foot & Ankle Surgery Podiatrist
Primary
DP00244
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
083431
—
OR
Enumeration date
08/29/2006
Last updated
03/07/2023
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