Provider Demographics
NPI:1295784569
Name:SOUTH, ALLEN GREGG (MD)
Entity type:Individual
Prefix:DR
First Name:ALLEN
Middle Name:GREGG
Last Name:SOUTH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1229 MADISON ST
Mailing Address - Street 2:SUITE 610
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98104-3586
Mailing Address - Country:US
Mailing Address - Phone:206-709-8600
Mailing Address - Fax:206-215-2690
Practice Address - Street 1:1229 MADISON ST
Practice Address - Street 2:SUITE 610
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98104-3586
Practice Address - Country:US
Practice Address - Phone:206-709-8600
Practice Address - Fax:206-215-2690
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-06
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WAMD00013266207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1826304Medicaid
WA06038900OtherL AND I
WA06038900OtherL AND I
WA06038900OtherL AND I
WAAS5658212OtherDEA