| Doctor Name: | MICHAEL R VANALLEN |
| NPI Number: | 1912906405 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | |
| License Number: | MD15401 |
| Business Practice Address: | 19255 Sw 65th Ave Suite 210 Tualatin, OR - 970627451 |
| Business Phone Number: | 5036928907 |
| Business Fax Number: | 5036120524 |
| Mailing Address: | 19255 Sw 65th Ave, Suite 210 TUALATIN |
| State: | OR |
| Postal Code: | 970627451 |
| Phone Number: | 5036928907 |
| Fax Number: | 5036120524 |
| NPI Enumeration Date: | 07/18/2005 |
| NPI Last Update Date: | 07/28/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | 03/18/2006 |
| NPI Reactivation Date: | 03/28/2006 |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 174400000X |
| License Number: | MD15401 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | OR |
| Taxonomy Type: | Other Service Providers |
| Taxonomy Classification: | Specialist |
| Taxonomy Specialization: | |
| Taxonomy Definition: | An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree. |