Individual
ALICE SO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
3377 RIVERBEND DR, SPRINGFIELD, OR 97477-8803
(541) 222-6389
(541) 222-6385
Mailing address
44 BIRCH ST, SUITE 201, DERRY, NH 03038-2752
(603) 421-2384
(603) 421-2388
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
13564
NH
208M00000X
Hospitalist Physician
13564
NH
208M00000X
Hospitalist Physician
Primary
MD174884
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
30206568
—
NH
Enumeration date
08/31/2006
Last updated
02/12/2020
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