Basic Information
Provider Information
NPI: 1194906016
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: ALLER
FirstName: CYNTHIA
MiddleName: BARBARA
NamePrefix: DR.
NameSuffix:  
Credential: D.O., PH.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX 3360
Address2:  
City: PORTLAND
State: OR
PostalCode: 972083360
CountryCode: US
TelephoneNumber:  
FaxNumber:  
Practice Location
Address1: 4525 3RD AVE SE
Address2: STE 200
City: LACEY
State: WA
PostalCode: 985031010
CountryCode: US
TelephoneNumber: 3607543934
FaxNumber: 3609438023
Other Information
ProviderEnumerationDate: 11/20/2007
LastUpdateDate: 04/05/2021
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 04/05/2021

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207RH0003XOP60446166WAY Allopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology

No ID Information.


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