Provider Demographics
NPI:1144273988
Name:PAUL J ALLEN MD PLLC
Entity type:Organization
Organization Name:PAUL J ALLEN MD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:J
Authorized Official - Last Name:ALLEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:360-352-8800
Mailing Address - Street 1:PO BOX 12840
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98508-2840
Mailing Address - Country:US
Mailing Address - Phone:360-352-8800
Mailing Address - Fax:
Practice Address - Street 1:2938 LIMITED LN NW
Practice Address - Street 2:STE B
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98502
Practice Address - Country:US
Practice Address - Phone:360-352-8800
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-19
Last Update Date:2012-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00027976208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0180143OtherDEPT OF LABOR & INDUSTRY
WA1062819Medicaid
WA65493OtherDEPT OF LABOR & INDUSTRY
WA1062819Medicaid
WA65493OtherDEPT OF LABOR & INDUSTRY