Provider Demographics
NPI:1467432245
Name:SOO, ALLAN M (MD)
Entity Type:Individual
Prefix:
First Name:ALLAN
Middle Name:M
Last Name:SOO
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 1:1265 W GUADALUPE RD
Mailing Address - Street 2:STE NPPES
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85202-9101
Mailing Address - Country:US
Mailing Address - Phone:480-775-6038
Mailing Address - Fax:
Practice Address - Street 1:1265 W GUADALUPE RD
Practice Address - Street 2:STE NPPES
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85202-9101
Practice Address - Country:US
Practice Address - Phone:480-775-6038
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-18
Last Update Date:2012-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ20313207ZP0102X, 2083X0100X, 207P00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
No2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ120952Medicare PIN
AZE32815Medicare UPIN
AZZ126485Medicare UPIN