Provider Demographics
NPI:1245270230
Name:WACHTER, ALLAN M (MD)
Entity type:Individual
Prefix:DR
First Name:ALLAN
Middle Name:M
Last Name:WACHTER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:12020 S WARNER ELLIOT LOOP
Mailing Address - Street 2:SUITE 124
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85044-2700
Mailing Address - Country:US
Mailing Address - Phone:480-785-8000
Mailing Address - Fax:480-705-8129
Practice Address - Street 1:12020 S WARNER ELLIOT LOOP
Practice Address - Street 2:SUITE 124
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85044-2700
Practice Address - Country:US
Practice Address - Phone:480-785-8000
Practice Address - Fax:480-705-8129
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-07
Last Update Date:2011-05-12
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
AZ17145207KA0200X, 207RA0201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207KA0200XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyAllergy
No207RA0201XAllopathic & Osteopathic PhysiciansInternal MedicineAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ1Z3872OtherHEALTH NET AZ
AZ27995201Medicaid
AZ826036OtherAETNA
AZAZ0807640OtherBCBS
AZ826036OtherAETNA