Provider Demographics
NPI:1790304665
Name:HOWARD, MICHAEL ANTHONY JAMES
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:ANTHONY JAMES
Last Name:HOWARD
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:435 N 5TH ST
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85004-2157
Mailing Address - Country:US
Mailing Address - Phone:602-827-2450
Mailing Address - Fax:
Practice Address - Street 1:435 N 5TH ST
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85004-2157
Practice Address - Country:US
Practice Address - Phone:602-827-2450
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-10
Last Update Date:2020-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant