Provider Demographics
NPI:1790750594
Name:ALLEN, IRA STEVEN (MD)
Entity Type:Individual
Prefix:DR
First Name:IRA
Middle Name:STEVEN
Last Name:ALLEN
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 1:13103 E MANSFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:SPOKANE VALLEY
Mailing Address - State:WA
Mailing Address - Zip Code:99216-1642
Mailing Address - Country:US
Mailing Address - Phone:509-892-2700
Mailing Address - Fax:
Practice Address - Street 1:1280 116TH AVE NE
Practice Address - Street 2:SUITE 210
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98004-3803
Practice Address - Country:US
Practice Address - Phone:425-646-0922
Practice Address - Fax:425-646-0925
Is Sole Proprietor?:No
Enumeration Date:2006-02-23
Last Update Date:2014-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00028379207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8477143Medicaid
WA8477143Medicaid
WAGAB01305Medicare PIN
WAGAB34593Medicare PIN
WA220009555Medicare PIN
WAG000165903Medicare PIN