1265425250 NPI number — ALLEN D SOFFER MD

Table of content: (NPI 1821190331)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1265425250 NPI number — ALLEN D SOFFER MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SOFFER
Provider First Name:
ALLEN
Provider Middle Name:
D
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1265425250
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/19/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
450 N. NEW BALLAS RD.
Provider Second Line Business Mailing Address:
SUITE 270 WEST WING
Provider Business Mailing Address City Name:
ST. LOUIS
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
63141
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
314-991-6969
Provider Business Mailing Address Fax Number:
314-997-6969

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
450 N. NEW BALLAS RD.
Provider Second Line Business Practice Location Address:
SUITE 270 WEST WING
Provider Business Practice Location Address City Name:
ST. LOUIS
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
63141
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
314-991-6969
Provider Business Practice Location Address Fax Number:
314-997-6969
Provider Enumeration Date:
08/25/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207RC0000X , with the licence number:  R5F98 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207RC0000X , with the licence number: 036-079446 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1881863009 . This is a "FARM GROUP NP" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 007013185 . This is a "MEDICARE PROV ID AREA 99" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: CD6536 . This is a "RR GROUP 01" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 001012762 . This is a "AREA 01 MEDICARE" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 060041760 . This is a "RR MEDICARE NUMBER" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 1124011010 . This is a "HHC CATH GROUP NPI" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 1801889795 . This is a "STL GROUP NPI" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: CI7050 . This is a "RR GROUP 99" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".




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