Basic Information
| Provider Information | |||||||||
| NPI: | 1508969122 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | VINCENT J HONAN MD PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1300 12TH STR | ||||||||
| Address2: | #518 | ||||||||
| City: | PHOENIX | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 850062849 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6022579488 | ||||||||
| FaxNumber: | 6022544258 | ||||||||
| Practice Location | |||||||||
| Address1: | 1300 12TH STR | ||||||||
| Address2: | #518 | ||||||||
| City: | PHOENIX | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 850062849 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6022579488 | ||||||||
| FaxNumber: | 6022544258 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/07/2006 | ||||||||
| LastUpdateDate: | 05/28/2008 | ||||||||
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| AuthorizedOfficialLastName: | HONAN | ||||||||
| AuthorizedOfficialFirstName: | VINCENT | ||||||||
| AuthorizedOfficialMiddleName: | J | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 6022579488 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RG0100X | 19895 | AZ | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Gastroenterology |
ID Information
| ID | Type | State | Issuer | Description | 105892 | 05 | AZ | MEDICAID |