Provider Demographics
NPI:1922077973
Name:KANE, DAVID HENACH (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:HENACH
Last Name:KANE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:2275 NE DOCTORS DR
Mailing Address - Street 2:SUITE 2
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97701
Mailing Address - Country:US
Mailing Address - Phone:541-585-2400
Mailing Address - Fax:541-585-2407
Practice Address - Street 1:2275 NE DOCTORS DR
Practice Address - Street 2:SUITE 2
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97701-6324
Practice Address - Country:US
Practice Address - Phone:541-585-2400
Practice Address - Fax:541-585-2407
Is Sole Proprietor?:No
Enumeration Date:2006-03-14
Last Update Date:2012-01-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZ31667207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ805442Medicaid
AZ76487Medicare ID - Type UnspecifiedPROVIDER NUMBER
AZ805442Medicaid