Bengtson, George W
Bengtson, George W is an individual health care provider with primary practice located at 4212 Ne Broadway St , Portland OR 97213-1460. He recently has only one registered license in Allopathic & Osteopathic Physicians / Pediatrics, which is considered as his primary health care specialty. Bengtson, George W can be contacted via phone (503) 249-8787.Contact Information
Primary practice address
4212 Ne Broadway St
Portland OR 97213-1460
Phone: (503) 249-8787
Fax:
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Pediatrics | 208000000X | MD 17053 | Oregon |
Profile Details
| NPI number | 1003983487 |
|---|---|
| LBN Legal business name | Bengtson, George W |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Nov 29th, 2006 |
| Last updated | Oct 28th, 2010 - about 14 years ago |
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.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1003983487 | NPPES |
| Oregon | MEDICAID | 05926-6 |
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