Provider Demographics
NPI:1518972025
Name:ZALLEN, GARRET SETH (MD)
Entity Type:Individual
Prefix:
First Name:GARRET
Middle Name:SETH
Last Name:ZALLEN
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 1:1115 SE 164TH AVE DEPT 358
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98683-8004
Mailing Address - Country:US
Mailing Address - Phone:541-222-6135
Mailing Address - Fax:541-222-6134
Practice Address - Street 1:3377 RIVERBEND DR
Practice Address - Street 2:PEDIATRIC SURGERY
Practice Address - City:SPRINGFIELD
Practice Address - State:OR
Practice Address - Zip Code:97477-8803
Practice Address - Country:US
Practice Address - Phone:541-222-6135
Practice Address - Fax:541-222-6134
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2016-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD252982086S0120X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0120XAllopathic & Osteopathic PhysiciansSurgeryPediatric Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR233404Medicaid