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Organization
PDX ALLERGY LLC
Active
Organization
PDX ALLERGY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ANGIE MERRIAM (PRACTICE MANAGER)
(971) 358-5600
Entity
Organization
Contact information
Practice address
8740 SE SUNNYBROOK BLVD STE 300, CLACKAMAS, OR 97015-5737
(971) 358-5600
(971) 358-5601
Mailing address
9200 SE 91ST AVE STE 220, HAPPY VALLEY, OR 97086-3756
(971) 358-5600
(971) 358-5601
Taxonomy
Speciality
Code
Description
License number
State
207K00000X
Allergy & Immunology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1447874367
—
OR
05
—
500784605
—
OR
Enumeration date
06/05/2020
Last updated
04/08/2024
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