Provider Demographics
NPI:1265425250
Name:SOFFER, ALLEN D (MD)
Entity type:Individual
Prefix:
First Name:ALLEN
Middle Name:D
Last Name:SOFFER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:450 N. NEW BALLAS RD.
Mailing Address - Street 2:SUITE 270 WEST WING
Mailing Address - City:ST. LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63141
Mailing Address - Country:US
Mailing Address - Phone:314-991-6969
Mailing Address - Fax:314-997-6969
Practice Address - Street 1:450 N. NEW BALLAS RD.
Practice Address - Street 2:SUITE 270 WEST WING
Practice Address - City:ST. LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63141
Practice Address - Country:US
Practice Address - Phone:314-991-6969
Practice Address - Fax:314-997-6969
Is Sole Proprietor?:No
Enumeration Date:2005-08-25
Last Update Date:2016-01-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MOR5F98207RC0000X
IL036-079446207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1881863009OtherFARM GROUP NP
MO007013185OtherMEDICARE PROV ID AREA 99
MOCD6536OtherRR GROUP 01
MO001012762OtherAREA 01 MEDICARE
MO060041760OtherRR MEDICARE NUMBER
MO1124011010OtherHHC CATH GROUP NPI
MO1801889795OtherSTL GROUP NPI
MOCI7050OtherRR GROUP 99
MO060041760OtherRR MEDICARE NUMBER