Provider Demographics
NPI:1710969340
Name:ALLISON, GINA R (MD)
Entity Type:Individual
Prefix:
First Name:GINA
Middle Name:R
Last Name:ALLISON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:GINA
Other - Middle Name:
Other - Last Name:VAUGHN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7650 SW BEVELAND RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97223-8692
Mailing Address - Country:US
Mailing Address - Phone:503-692-1242
Mailing Address - Fax:503-691-3615
Practice Address - Street 1:19250 SW 65TH AVE
Practice Address - Street 2:SUITE 300
Practice Address - City:TUALATIN
Practice Address - State:OR
Practice Address - Zip Code:97062-7452
Practice Address - Country:US
Practice Address - Phone:503-692-1242
Practice Address - Fax:503-691-3615
Is Sole Proprietor?:No
Enumeration Date:2005-11-18
Last Update Date:2018-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD 25619207V00000X
ORMD25619207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR213564Medicaid
ORR132456OtherMEDICARE PTAN
OR213564Medicaid