Provider Demographics
NPI:1346328580
Name:SOARES, ASSIS (MD)
Entity Type:Individual
Prefix:
First Name:ASSIS
Middle Name:
Last Name:SOARES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 MEDICAL PARK
Mailing Address - Street 2:
Mailing Address - City:TALLADEGA
Mailing Address - State:AL
Mailing Address - Zip Code:35160-2259
Mailing Address - Country:US
Mailing Address - Phone:256-362-9239
Mailing Address - Fax:256-761-1704
Practice Address - Street 1:401 MEDICAL PARK
Practice Address - Street 2:
Practice Address - City:TALLADEGA
Practice Address - State:AL
Practice Address - Zip Code:35160-2259
Practice Address - Country:US
Practice Address - Phone:256-362-9239
Practice Address - Fax:256-761-1704
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-02
Last Update Date:2011-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL10380208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL000010678Medicaid
AL000010678Medicaid
AL000010678Medicare ID - Type Unspecified