Healthcare Provider Details

I. General information

NPI: 1467432245
Provider Name (Legal Business Name): ALLAN M SOO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/18/2006
Last Update Date: 09/18/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1265 W GUADALUPE RD STE NPPES
MESA AZ
85202-9101
US

IV. Provider business mailing address

1265 W GUADALUPE RD STE NPPES
MESA AZ
85202-9101
US

V. Phone/Fax

Practice location:
  • Phone: 480-775-6038
  • Fax:
Mailing address:
  • Phone: 480-775-6038
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number20313
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number20313
License Number StateAZ
# 3
Primary TaxonomyN
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number20313
License Number StateAZ
# 4
Primary TaxonomyN
Taxonomy Code2083X0100X
TaxonomyOccupational Medicine Physician
License Number20313
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: