Provider Demographics
NPI:1609092204
Name:DODD, ALLEN (LMP)
Entity Type:Individual
Prefix:
First Name:ALLEN
Middle Name:
Last Name:DODD
Suffix:
Gender:M
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3420 NE 7TH ST
Mailing Address - Street 2:
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98056-3847
Mailing Address - Country:US
Mailing Address - Phone:425-255-2042
Mailing Address - Fax:
Practice Address - Street 1:22226 6TH AVE S STE 101
Practice Address - Street 2:
Practice Address - City:DES MOINES
Practice Address - State:WA
Practice Address - Zip Code:98198-6246
Practice Address - Country:US
Practice Address - Phone:206-824-7200
Practice Address - Fax:206-824-7720
Is Sole Proprietor?:No
Enumeration Date:2007-04-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00018970174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist