Provider Demographics
NPI:1508969122
Name:VINCENT J HONAN MD PC
Entity Type:Organization
Organization Name:VINCENT J HONAN MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:VINCENT
Authorized Official - Middle Name:J
Authorized Official - Last Name:HONAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:602-257-9488
Mailing Address - Street 1:1300 12TH STR
Mailing Address - Street 2:#518
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85006-2849
Mailing Address - Country:US
Mailing Address - Phone:602-257-9488
Mailing Address - Fax:602-254-4258
Practice Address - Street 1:1300 12TH STR
Practice Address - Street 2:#518
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85006-2849
Practice Address - Country:US
Practice Address - Phone:602-257-9488
Practice Address - Fax:602-254-4258
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-07
Last Update Date:2008-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ19895207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ105892Medicaid
AZ105892Medicaid
F25721Medicare UPIN