Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207N00000X | Dermatologist | 2006015208 | MO |
Y | 207ND0101X | MOHS-Micrographic Surgeon | MD27518 | OR |
NPI | 1346344611 |
---|---|
Provider Name | Mrs. Erin J Allen |
First Address | Portland, OR 97208-3158 |
Second Address | Portland, OR 97213-3069 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/09/2006 |
Last Update Date | 02/10/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
274601 | (05) | OR |
P00609309 | RR MEDICARE (01) | OR |