=====================================================
General NPI Number Information
=====================================================
NPI Number | 1215150313
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | LOWER COLUMBIA HEAD & NECK ASSOCIATES PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/10/2007
-----------------------------------------------------
Last Update Date | 09/11/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 820 11TH AVE
-----------------------------------------------------
City | LONGVIEW
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98632-2072
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 360-423-0960
-----------------------------------------------------
Fax | 360-423-8902
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 820 11TH AVE
-----------------------------------------------------
City | LONGVIEW
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98632-2072
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 360-423-0960
-----------------------------------------------------
Fax | 360-423-8902
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | ALEXANDER P IEROKOMOS
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 360-423-0960
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Y00000X
-----------------------------------------------------
Taxonomy Name | Otolaryngology Physician
-----------------------------------------------------
License Number | MD00022010
-----------------------------------------------------
License Number State | WA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207YP0228X
-----------------------------------------------------
Taxonomy Name | Pediatric Otolaryngology Physician
-----------------------------------------------------
License Number | MD00022010
-----------------------------------------------------
License Number State | WA
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 207YS0012X
-----------------------------------------------------
Taxonomy Name | Sleep Medicine (Otolaryngology) Physician
-----------------------------------------------------
License Number | MD00022010
-----------------------------------------------------
License Number State | WA
-----------------------------------------------------
Taxonomy #4
-----------------------------------------------------
Taxonomy Code | 207YX0007X
-----------------------------------------------------
Taxonomy Name | Plastic Surgery within the Head & Neck (Otolaryngology) Physician
-----------------------------------------------------
License Number | MD00022010
-----------------------------------------------------
License Number State | WA
-----------------------------------------------------
Taxonomy #5
-----------------------------------------------------
Taxonomy Code | 207YX0602X
-----------------------------------------------------
Taxonomy Name | Otolaryngic Allergy Physician
-----------------------------------------------------
License Number | MD00022010
-----------------------------------------------------
License Number State | WA
-----------------------------------------------------
Taxonomy #6
-----------------------------------------------------
Taxonomy Code | 207YX0905X
-----------------------------------------------------
Taxonomy Name | Otolaryngology/Facial Plastic Surgery Physician
-----------------------------------------------------
License Number | MD00022010
-----------------------------------------------------
License Number State | WA
-----------------------------------------------------
Taxonomy #7
-----------------------------------------------------
Taxonomy Code | 204E00000X
-----------------------------------------------------
Taxonomy Name | Oral & Maxillofacial Surgery (D.M.D.)
-----------------------------------------------------
License Number | MD00022010
-----------------------------------------------------
License Number State | WA
-----------------------------------------------------