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General NPI Number Information
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NPI Number | 1750324968
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Entity Type | Individual
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Provider Name | PAUL HOWARD ALLEN MD
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Gender | Male
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Dates
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Enumeration Date | 06/14/2006
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Last Update Date | 05/22/2008
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Provider Practice Location Address
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Address Line | 98 POPLAR STREET
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City | BLACKFOOT
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State | ID
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Zip | 83221-1758
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Country | US
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Telephone | 208-785-4100
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Fax | 208-785-3818
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Provider Business Mailing Address
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Address Line | 505 S 336TH ST SUITE 336
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City | FEDERAL WAY
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State | WA
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Zip | 98003-6328
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Country | US
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Telephone | 253-838-6180
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Fax | 253-838-6418
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | M-4622
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License Number State | ID
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