Provider Demographics
NPI:1073585014
Name:HONAN, VINCENT J (MD)
Entity Type:Individual
Prefix:DR
First Name:VINCENT
Middle Name:J
Last Name:HONAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3020 E CAMELBACK RD
Mailing Address - Street 2:SUITE 301
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85016-5095
Mailing Address - Country:US
Mailing Address - Phone:602-264-9100
Mailing Address - Fax:602-264-9101
Practice Address - Street 1:9250 N 3RD ST
Practice Address - Street 2:STE 2015
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85020-5059
Practice Address - Country:US
Practice Address - Phone:602-279-3575
Practice Address - Fax:602-279-2666
Is Sole Proprietor?:No
Enumeration Date:2006-02-03
Last Update Date:2017-02-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZ19895207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ317047OtherMEDICAID GROUP NUMBER
AZ105892Medicaid
AZ120390OtherMEDICARE GROUP NUMBER
AZ120390OtherMEDICARE GROUP NUMBER
F25721Medicare UPIN
AZ120611Medicare PIN