Basic Information
| Provider Information | |||||||||
| NPI: | 1912347675 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | ALLENSWORTH | ||||||||
| FirstName: | JORDAN | ||||||||
| MiddleName: | JAMES | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3181 SW SAM JACKSON PARK RD | ||||||||
| Address2: | OHSU | ||||||||
| City: | PORTLAND | ||||||||
| State: | OR | ||||||||
| PostalCode: | 972393011 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5034948220 | ||||||||
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| Practice Location | |||||||||
| Address1: | 417 SE 164TH AVE STE 300 | ||||||||
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| City: | VANCOUVER | ||||||||
| State: | WA | ||||||||
| PostalCode: | 986848944 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3602564425 | ||||||||
| FaxNumber: | 3602562474 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/26/2013 | ||||||||
| LastUpdateDate: | 07/16/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 07/16/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 207Y00000X | MD61144936 | WA | Y | Allopathic & Osteopathic Physicians | Otolaryngology |
No ID Information.