Provider Demographics
NPI:1831204882
Name:HELLER, ALAN MAX (MD)
Entity type:Individual
Prefix:
First Name:ALAN
Middle Name:MAX
Last Name:HELLER
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 1:2039 FOREST AVE
Mailing Address - Street 2:STE. 203
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95128-4817
Mailing Address - Country:US
Mailing Address - Phone:408-297-6030
Mailing Address - Fax:408-297-8612
Practice Address - Street 1:2039 FOREST AVE
Practice Address - Street 2:STE. 203
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95128-4817
Practice Address - Country:US
Practice Address - Phone:408-297-6030
Practice Address - Fax:408-297-8612
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA32272207KA0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207KA0200XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyAllergy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA32272OtherSTATE LICENSE
A26745Medicare UPIN
00A322720Medicare ID - Type Unspecified