Healthcare Provider Details

I. General information

NPI: 1265425250
Provider Name (Legal Business Name): ALLEN D SOFFER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/25/2005
Last Update Date: 01/19/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

450 N. NEW BALLAS RD. SUITE 270 WEST WING
ST. LOUIS MO
63141
US

IV. Provider business mailing address

450 N. NEW BALLAS RD. SUITE 270 WEST WING
ST. LOUIS MO
63141
US

V. Phone/Fax

Practice location:
  • Phone: 314-991-6969
  • Fax: 314-997-6969
Mailing address:
  • Phone: 314-991-6969
  • Fax: 314-997-6969

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberR5F98
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number036-079446
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: