Provider Demographics
NPI:1336233402
Name:ALLEN, ERIC ANDREW (DPM)
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:ANDREW
Last Name:ALLEN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1519 3RD ST SE STE 101
Mailing Address - Street 2:
Mailing Address - City:PUYALLUP
Mailing Address - State:WA
Mailing Address - Zip Code:98372-3742
Mailing Address - Country:US
Mailing Address - Phone:253-841-0705
Mailing Address - Fax:253-841-4527
Practice Address - Street 1:1519 3RD ST SE STE 101
Practice Address - Street 2:
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98372-3742
Practice Address - Country:US
Practice Address - Phone:253-838-7980
Practice Address - Fax:253-874-0885
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2023-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAP000000690213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8322943Medicaid
WA0158886OtherL AND I
WA8322943Medicaid
WA0158886OtherL AND I