Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0120X | Pediatric Surgery | MD25298 | OR |
NPI | 1518972025 |
---|---|
Provider Name | Garret Seth Zallen |
First Address | Vancouver, WA 98683-8004 |
Second Address | Springfield, OR 97477-8803 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/07/2006 |
Last Update Date | 03/03/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
233404 | (05) | OR |