Provider Demographics
NPI:1750324968
Name:ALLEN, PAUL HOWARD (MD)
Entity type:Individual
Prefix:
First Name:PAUL
Middle Name:HOWARD
Last Name:ALLEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:505 S 336TH ST
Mailing Address - Street 2:SUITE 336
Mailing Address - City:FEDERAL WAY
Mailing Address - State:WA
Mailing Address - Zip Code:98003-6328
Mailing Address - Country:US
Mailing Address - Phone:253-838-6180
Mailing Address - Fax:253-838-6418
Practice Address - Street 1:98 POPLAR STREET
Practice Address - Street 2:
Practice Address - City:BLACKFOOT
Practice Address - State:ID
Practice Address - Zip Code:83221-1758
Practice Address - Country:US
Practice Address - Phone:208-785-4100
Practice Address - Fax:208-785-3818
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-14
Last Update Date:2008-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDM-4622207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID000010140861OtherBSID
WA6499ALOtherBSWA
WA8945381OtherVICTIMS OF CRIME
WA0194430OtherLIWA
6059600 07OtherUSDLAB
ID003572600Medicaid
ID51672OtherBCID
UTZ2572Medicaid
WA1026806Medicaid
ID1118485Medicaid
ID000010140861OtherBSID
WA8945381OtherVICTIMS OF CRIME
ID1118485Medicaid
WA1026806Medicaid