Individual
FREDERICK M BOLZENDAHL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
3710 SW US VETERANS RD, PORTLAND, OR 97207
(503) 220-8262
Mailing address
15515 NE 25TH AVE, VANCOUVER, WA 98686
(360) 571-9416
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA00507
OR
Other
Enumeration date
09/15/2006
Last updated
07/08/2007
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