Provider Demographics
NPI:1558496158
Name:ALLRED, STEPHEN III (NP)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:
Last Name:ALLRED
Suffix:III
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:135 SE 102ND AVE
Mailing Address - Street 2:GETAFLUSHOTCOM
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97216-2703
Mailing Address - Country:US
Mailing Address - Phone:503-258-9800
Mailing Address - Fax:503-258-8311
Practice Address - Street 1:135 SE 102ND AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97216-2703
Practice Address - Country:US
Practice Address - Phone:503-258-9800
Practice Address - Fax:503-258-8311
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-22
Last Update Date:2008-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR081047114N3 ANP-PP363LA2200X
WAAP30003743363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAAB26796Medicare ID - Type UnspecifiedKING COUNTY
ORR112014Medicare ID - Type Unspecified
WAAB26795Medicare ID - Type UnspecifiedNON KING COUNTY