Provider Demographics
NPI:1275526238
Name:SOSSAN, ALLEN A (DO)
Entity Type:Individual
Prefix:DR
First Name:ALLEN
Middle Name:A
Last Name:SOSSAN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:109 N 29TH ST
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:NE
Mailing Address - Zip Code:68701-3261
Mailing Address - Country:US
Mailing Address - Phone:402-371-0839
Mailing Address - Fax:402-371-0840
Practice Address - Street 1:109 N 29TH ST
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:NE
Practice Address - Zip Code:68701-3261
Practice Address - Country:US
Practice Address - Phone:402-371-0839
Practice Address - Fax:402-371-0840
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-25
Last Update Date:2011-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE390207XS0117X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the Spine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10025272500Medicaid
SD6402460Medicaid
SDS102585Medicare PIN
NE10025272500Medicaid
SD6402460Medicaid