Provider Demographics
NPI:1841383825
Name:ALLEN, DANIEL REX (PHYSICIAN ASSISTANT)
Entity Type:Individual
Prefix:MR
First Name:DANIEL
Middle Name:REX
Last Name:ALLEN
Suffix:
Gender:M
Credentials:PHYSICIAN ASSISTANT
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 307
Mailing Address - Street 2:
Mailing Address - City:FOSSIL
Mailing Address - State:OR
Mailing Address - Zip Code:97830-0307
Mailing Address - Country:US
Mailing Address - Phone:541-763-2725
Mailing Address - Fax:541-763-2850
Practice Address - Street 1:712 JAY STREET
Practice Address - Street 2:
Practice Address - City:FOSSIL
Practice Address - State:OR
Practice Address - Zip Code:97830-0307
Practice Address - Country:US
Practice Address - Phone:541-763-2725
Practice Address - Fax:541-763-2850
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2013-04-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
ORPA01163363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORP19893Medicare UPIN