Provider Demographics
NPI:1275622441
Name:MCALLISTER, WILLIAM R (MD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:R
Last Name:MCALLISTER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9155 SW BARNES RD STE 940
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97225-6636
Mailing Address - Country:US
Mailing Address - Phone:503-297-1351
Mailing Address - Fax:503-297-2851
Practice Address - Street 1:9155 SW BARNES RD STE 940
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97225-6636
Practice Address - Country:US
Practice Address - Phone:503-297-1351
Practice Address - Fax:503-297-2851
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2011-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR06467174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR118844Medicaid
00WCGZRAMedicare ID - Type Unspecified
OR118844Medicaid