Provider Demographics
NPI:1740366913
Name:ALLEN, GEORGE S (MD)
Entity type:Individual
Prefix:
First Name:GEORGE
Middle Name:S
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 1:8506 E MILL PLAIN BLVD
Mailing Address - Street 2:SUITE A
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98664-2011
Mailing Address - Country:US
Mailing Address - Phone:360-896-2222
Mailing Address - Fax:360-896-8881
Practice Address - Street 1:8506 E MILL PLAIN BLVD
Practice Address - Street 2:SUITE A
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98664-2011
Practice Address - Country:US
Practice Address - Phone:360-896-2222
Practice Address - Fax:360-896-8881
Is Sole Proprietor?:No
Enumeration Date:2006-10-31
Last Update Date:2017-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00042579207K00000X
ORMD24825207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
8801396Medicare ID - Type Unspecified
H62705Medicare UPIN