Organization
EASTSIDE ALLERGY ASTHMA & GENERAL INTERNAL MEDICINE PC
Active
Parent organization
EASTSIDE ALLERGY, ASTHMA & GENERAL INTERNAL MEDICINE PC
Organization subpart
Yes
Provider details
NPI number
Legal business name
EASTSIDE ALLERGY, ASTHMA & GENERAL INTERNAL MEDICINE PC
Authorized official
DR. AUSTIN UNDERWOOD SARGENT M.D. PHD (PRESIDENT/OWNER)
(503) 666-5025
Entity
Organization
Contact information
Practice address
2850 SE POWELL BLVD, SUITE 206, GRESHAM, OR 97080-1494
(503) 666-5025
(503) 666-5795
Mailing address
2850 SE POWELL BLVD, SUITE 206, GRESHAM, OR 97080-1494
(503) 666-5025
(503) 666-5795
Taxonomy
Speciality
Code
Description
License number
State
207KA0200X
Allergy Physician
Primary
MD21072
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
151110
—
OR
Enumeration date
02/02/2011
Last updated
02/02/2011
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