Provider Demographics
NPI:1780636761
Name:AU, ALLAN RICHARD (MD)
Entity Type:Individual
Prefix:
First Name:ALLAN
Middle Name:RICHARD
Last Name:AU
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:9727 ELK GROVE FLORIN RD STE 180
Mailing Address - Street 2:
Mailing Address - City:ELK GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:95624-2267
Mailing Address - Country:US
Mailing Address - Phone:916-686-8170
Mailing Address - Fax:916-685-8195
Practice Address - Street 1:9727 ELK GROVE FLORIN RD STE 180
Practice Address - Street 2:
Practice Address - City:ELK GROVE
Practice Address - State:CA
Practice Address - Zip Code:95624-2267
Practice Address - Country:US
Practice Address - Phone:916-686-8170
Practice Address - Fax:916-685-8195
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-17
Last Update Date:2013-04-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG76867207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG76867OtherBLUE CROSS
CA00G768670Medicaid
F65885Medicare UPIN