Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 204C00000X | Sports Medicine Doctor | G22085 | CA |
Y | 204C00000X | Sports Medicine Doctor | MD08126 | OR |
NPI | 1659422327 |
---|---|
Provider Name | Dr. Allen J Thomashefsky |
First Address | Ashland, OR 97520-1931 |
Second Address | Ashland, OR 97520-1931 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/01/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
A90744 | (02) |