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Organization

PORTLAND PAIN AND SPINE LLC

Active
Other names
BALOG Regenerative
Organization subpart
No

Provider details

NPI number
Authorized official
DR. CARL C BALOG MD (OWNER)
(503) 887-2209
Entity
Organization

Contact information

Practice address
9370 SW GREENBURG RD STE 601, TIGARD, OR 97223-5429
(503) 238-7246
(503) 238-7248
Mailing address
9370 SW GREENBURG RD STE 601, TIGARD, OR 97223-5429
(503) 238-7246
(503) 238-7248

Taxonomy

Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
MD19519
OR
207LP2900X
Pain Medicine (Anesthesiology) Physician
MD19519
OR
208VP0014X
Interventional Pain Medicine Physician
Primary

Other

Enumeration date
02/14/2012
Last updated
02/22/2024
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