Provider Demographics
NPI:1629006002
Name:SONI, DEVENDRA (MD)
Entity Type:Individual
Prefix:
First Name:DEVENDRA
Middle Name:
Last Name:SONI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14815 N DEL WEBB BLVD
Mailing Address - Street 2:
Mailing Address - City:SUN CITY
Mailing Address - State:AZ
Mailing Address - Zip Code:85351-2145
Mailing Address - Country:US
Mailing Address - Phone:623-977-3300
Mailing Address - Fax:623-977-6808
Practice Address - Street 1:14815 N DEL WEBB BLVD
Practice Address - Street 2:
Practice Address - City:SUN CITY
Practice Address - State:AZ
Practice Address - Zip Code:85351-2145
Practice Address - Country:US
Practice Address - Phone:623-977-3300
Practice Address - Fax:623-977-6808
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2011-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ27826207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZH06371Medicare UPIN