Provider Demographics
NPI:1689661134
Name:SOO HOO, ERIC R (MD)
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:R
Last Name:SOO HOO
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 1:3945 E PARADISE FALLS DR
Mailing Address - Street 2:# 105
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85712-6683
Mailing Address - Country:US
Mailing Address - Phone:520-797-7246
Mailing Address - Fax:520-795-4249
Practice Address - Street 1:3945 E PARADISE FALLS DR
Practice Address - Street 2:# 105
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85712-6683
Practice Address - Country:US
Practice Address - Phone:520-797-7246
Practice Address - Fax:520-795-4249
Is Sole Proprietor?:No
Enumeration Date:2005-09-30
Last Update Date:2009-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ112942083P0500X, 208VP0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083P0500XAllopathic & Osteopathic PhysiciansPreventive MedicinePreventive Medicine/Occupational Environmental Medicine
No208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ100259Medicaid
AZ100259Medicaid