Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN0400X | Neurology | 273228 | OR |
NPI | 1528004082 |
---|---|
Provider Name | Dr. Glen Zielinski |
First Address | Lake Oswego, OR 97035-1429 |
Second Address | Portland, OR 97209-3444 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/06/2006 |
Last Update Date | 08/07/2007 |