Healthcare Provider Details

I. General information

NPI: 1396320396
Provider Name (Legal Business Name): ERIC B ALLARD PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/11/2021
Last Update Date: 05/26/2022
Certification Date: 05/26/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1435 G ST
SPRINGFIELD OR
97477-4113
US

IV. Provider business mailing address

PO BOX 163
SPRINGFIELD OR
97477-0024
US

V. Phone/Fax

Practice location:
  • Phone: 541-735-9420
  • Fax: 541-747-9870
Mailing address:
  • Phone: 541-735-9420
  • Fax: 541-747-9870

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberPA201807
License Number StateOR
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA201807
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: