Provider Demographics
NPI:1891757449
Name:BAMBERL, JOHN A (DO)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:A
Last Name:BAMBERL
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Gender:M
Credentials:DO
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Mailing Address - Street 1:16620 N 40TH ST
Mailing Address - Street 2:SUITE E
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85032-3348
Mailing Address - Country:US
Mailing Address - Phone:602-467-0222
Mailing Address - Fax:602-467-0909
Practice Address - Street 1:16620 N 40TH ST
Practice Address - Street 2:SUITE E
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85032-3348
Practice Address - Country:US
Practice Address - Phone:602-467-0222
Practice Address - Fax:602-467-0909
Is Sole Proprietor?:No
Enumeration Date:2006-04-06
Last Update Date:2007-07-09
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
AZ1021208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZE84759Medicare UPIN