Healthcare Provider Details

I. General information

NPI: 1750822185
Provider Name (Legal Business Name): ALLEN GU MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/18/2017
Last Update Date: 08/22/2024
Certification Date: 08/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1750 E GLENDALE AVE
PHOENIX AZ
85020-4328
US

IV. Provider business mailing address

10063 TOULOUSE DR
SHREVEPORT LA
71106-8522
US

V. Phone/Fax

Practice location:
  • Phone: 602-242-4928
  • Fax: 602-249-4813
Mailing address:
  • Phone: 318-350-8141
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberMD61495259
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberMD218340
License Number StateOR
# 3
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number74056
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: