Provider Demographics
NPI:1679790604
Name:ALLERGY CLINIC LLC
Entity type:Organization
Organization Name:ALLERGY CLINIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:O'HOLLAREN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:503-228-0155
Mailing Address - Street 1:511 SW 10TH AVE
Mailing Address - Street 2:SUITE 1301
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97205-2732
Mailing Address - Country:US
Mailing Address - Phone:503-228-0155
Mailing Address - Fax:503-226-8342
Practice Address - Street 1:511 SW 10TH AVE
Practice Address - Street 2:SUITE 1301
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97205-2732
Practice Address - Country:US
Practice Address - Phone:503-228-0155
Practice Address - Fax:503-226-8342
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR13450207KA0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207KA0200XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyAllergyGroup - Single Specialty