Provider Demographics
NPI:1033405386
Name:DAMIAN, ALLAN MICHAEL (MD)
Entity Type:Individual
Prefix:DR
First Name:ALLAN
Middle Name:MICHAEL
Last Name:DAMIAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:ALLAN MICHAEL
Other - Middle Name:VERTUDEZ
Other - Last Name:DAMIAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:1400 E KINCAID ST
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:WA
Mailing Address - Zip Code:98274-4127
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1415 E KINCAID ST
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:WA
Practice Address - Zip Code:98274-4126
Practice Address - Country:US
Practice Address - Phone:360-428-2550
Practice Address - Fax:360-428-6402
Is Sole Proprietor?:No
Enumeration Date:2011-06-24
Last Update Date:2022-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXP9065208000000X
MO20210196612084S0012X
WAMD612927482084S0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084S0012XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologySleep Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics