Provider Demographics
NPI:1750822185
Name:GU, ALLEN (MD)
Entity type:Individual
Prefix:
First Name:ALLEN
Middle Name:
Last Name:GU
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 1:10063 TOULOUSE DR
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71106-8522
Mailing Address - Country:US
Mailing Address - Phone:318-350-8141
Mailing Address - Fax:
Practice Address - Street 1:1750 E GLENDALE AVE
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85020-4328
Practice Address - Country:US
Practice Address - Phone:602-242-4928
Practice Address - Fax:602-249-4813
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-18
Last Update Date:2024-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD61495259207W00000X
ORMD218340207W00000X
AZ74056207W00000X, 207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology