Provider Demographics
NPI:1700806445
Name:MEHR, ALLAN STEVEN (DA)
Entity Type:Individual
Prefix:DR
First Name:ALLAN
Middle Name:STEVEN
Last Name:MEHR
Suffix:
Gender:M
Credentials:DA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 RAMSGATE SQ S
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97302-5868
Mailing Address - Country:US
Mailing Address - Phone:503-364-2828
Mailing Address - Fax:503-364-4327
Practice Address - Street 1:120 RAMSGATE SQ S
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97302-5868
Practice Address - Country:US
Practice Address - Phone:503-364-2828
Practice Address - Fax:503-364-4327
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-19
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR20459237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR227819Medicaid
OR227819Medicaid