Basic Information
Provider Information
NPI: 1033640529
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: HON
FirstName: DEVIN
MiddleName: LEE
NamePrefix:  
NameSuffix:  
Credential: DO
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX 7060
Address2:  
City: CHANDLER
State: AZ
PostalCode: 852467060
CountryCode: US
TelephoneNumber: 4805366850
FaxNumber: 4807181301
Practice Location
Address1: 300 S PHELPS DR
Address2:  
City: APACHE JUNCTION
State: AZ
PostalCode: 851206700
CountryCode: US
TelephoneNumber: 4805366850
FaxNumber: 4807181301
Other Information
ProviderEnumerationDate: 03/25/2017
LastUpdateDate: 08/14/2020
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 08/14/2020

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207Q00000X008411AZY Allopathic & Osteopathic PhysiciansFamily Medicine 

No ID Information.


Home