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Individual

DR. PHILIP MANNING BOLTON

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
6400 SE LAKE RD STE 325, MILWAUKIE, OR 97222-2185
(503) 786-1711
(503) 786-9919
Mailing address
PO BOX 19134, PORTLAND, OR 97280-0134
(503) 245-5142

Taxonomy

Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
MD20092
OR

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
226895
OMAP PROVIDER #
OR
Enumeration date
06/29/2006
Last updated
06/03/2021
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