Individual
MICHAEL R VANALLEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M D P C
Contact information
Practice address
19255 SW 65TH AVE, SUITE 210, TUALATIN, OR 97062-7451
(503) 692-8907
(503) 612-0524
Mailing address
19255 SW 65TH AVE, SUITE 210, TUALATIN, OR 97062-7451
(503) 692-8907
(503) 612-0524
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
MD15401
OR
2086S0105X
Surgery of the Hand (Surgery) Physician
Primary
MD15401
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
93-1209679
MEDICARE
OR
Enumeration date
07/18/2005
Last updated
08/20/2019
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