Healthcare Provider Details

I. General information

NPI: 1801849849
Provider Name (Legal Business Name): ALLERGY ASTHMA & DERMATOLOGY ASSOCIATES PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/19/2006
Last Update Date: 10/04/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

233 NW 16TH AVE
PORTLAND OR
97209-2630
US

IV. Provider business mailing address

2415 NE 134TH ST SUITE 301
VANCOUVER WA
98686-3025
US

V. Phone/Fax

Practice location:
  • Phone: 503-226-6480
  • Fax: 503-294-1868
Mailing address:
  • Phone: 503-294-1866
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207KA0200X
TaxonomyAllergy Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207NS0135X
TaxonomyProcedural Dermatology Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207NI0002X
TaxonomyClinical & Laboratory Dermatological Immunology Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code207KI0005X
TaxonomyClinical & Laboratory Immunology (Allergy & Immunology) Physician
License Number
License Number State
# 6
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number
License Number State

VIII. Authorized Official

Name: JENNIFER M BICKLER
Title or Position: ADMINISTRATOR
Credential:
Phone: 503-294-6171