Healthcare Provider Details

I. General information

NPI: 1851304331
Provider Name (Legal Business Name): ALLAN JAY WEILAND M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/14/2006
Last Update Date: 07/16/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14406 NE 20TH AVE KAISER PERMANENTE SALMON CREEK MEDICAL OFFICE
VANCOUVER WA
98686-1448
US

IV. Provider business mailing address

14406 NE 20TH AVE KAISER PERMANENTE SALMON CREEK MEDICAL OFFICE
VANCOUVER WA
98686-1448
US

V. Phone/Fax

Practice location:
  • Phone: 360-571-4741
  • Fax: 360-571-4246
Mailing address:
  • Phone: 360-571-4741
  • Fax: 360-571-4246

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberMD10482
License Number StateOR
# 2
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberMD00016970
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: