Basic Information
| Provider Information | |||||||||
| NPI: | 1659300374 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ALLGAIER | ||||||||
| FirstName: | JEFFREY | ||||||||
| MiddleName: | TODD | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8514 W GAGE BLVD | ||||||||
| Address2: | SUITE G | ||||||||
| City: | KENNEWICK | ||||||||
| State: | WA | ||||||||
| PostalCode: | 993368108 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5092221275 | ||||||||
| FaxNumber: | 5094913031 | ||||||||
| Practice Location | |||||||||
| Address1: | 3345 39TH ST S STE 1 | ||||||||
| Address2: | |||||||||
| City: | FARGO | ||||||||
| State: | ND | ||||||||
| PostalCode: | 581047539 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8775221275 | ||||||||
| FaxNumber: | 5094913031 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/03/2006 | ||||||||
| LastUpdateDate: | 06/13/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207QA0401X | MD00046152 | WA | Y | Allopathic & Osteopathic Physicians | Family Medicine | Addiction Medicine |
ID Information
| ID | Type | State | Issuer | Description | 0218208 | 01 | WA | LIWA | OTHER | 0227596 | 01 | WA | LIWA | OTHER | 6593AL | 01 | WA | BSWA | OTHER | 8946277 | 01 | WA | VICTIMS OF CRIME | OTHER | 3752AL | 01 | WA | BSWA | OTHER | 0209137 | 01 | WA | LIWA | OTHER | 0216265 | 01 | WA | LIWA | OTHER | 2031254 | 05 | WA | MEDICAID | 3075AL | 01 | WA | BSWA | OTHER | 3079AL | 01 | WA | BSWA | OTHER | 8452922 | 05 | WA | MEDICAID | 605960012 | 01 | WA | USDLAB | OTHER |