Provider Demographics
NPI:1467477562
Name:SOONG, PEILY (MD)
Entity Type:Individual
Prefix:DR
First Name:PEILY
Middle Name:
Last Name:SOONG
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 1:520 SIMMONS DR
Mailing Address - Street 2:
Mailing Address - City:TRUSSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35173-2367
Mailing Address - Country:US
Mailing Address - Phone:205-836-8691
Mailing Address - Fax:205-836-8691
Practice Address - Street 1:520 SIMMONS DR
Practice Address - Street 2:
Practice Address - City:TRUSSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35173-2367
Practice Address - Country:US
Practice Address - Phone:205-836-8691
Practice Address - Fax:205-836-8691
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2018-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL25081208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL2461154OtherUNITED HEALTHCARE
AL51522381OtherBC/BS
AL009953275Medicaid
AL51522382OtherBC/BS