Provider Demographics
NPI:1871507491
Name:ALLEN, ELIZABETH SHAW (MD)
Entity Type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:SHAW
Last Name:ALLEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3710 SW US VETERANS HOSPITAL RD
Mailing Address - Street 2:PORTLAND VA MEDICAL CENTER, P3-MED, P.O. BOX 1034
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97239-2964
Mailing Address - Country:US
Mailing Address - Phone:503-220-8262
Mailing Address - Fax:503-721-7807
Practice Address - Street 1:3710 SW US VETERANS HOSPITAL RD
Practice Address - Street 2:PORTLAND VA MEDICAL CENTER, P3-MED
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97207-1034
Practice Address - Country:US
Practice Address - Phone:503-220-8262
Practice Address - Fax:503-721-7807
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-28
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR17738207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORVAD 000Medicare UPIN