Provider Demographics
NPI:1073585014
Name:HONAN, VINCENT J (MD)
Entity type:Individual
Prefix:DR
First Name:VINCENT
Middle Name:J
Last Name:HONAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5343 E PALOMINO RD
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85018-1911
Mailing Address - Country:US
Mailing Address - Phone:602-677-2798
Mailing Address - Fax:928-773-2548
Practice Address - Street 1:77 W FOREST AVE STE 210
Practice Address - Street 2:
Practice Address - City:FLAGSTAFF
Practice Address - State:AZ
Practice Address - Zip Code:86001-1481
Practice Address - Country:US
Practice Address - Phone:928-773-2547
Practice Address - Fax:928-773-2548
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-03
Last Update Date:2024-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ19895207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ105892Medicaid
AZ317047OtherMEDICAID GROUP NUMBER
AZ120390OtherMEDICARE GROUP NUMBER
AZ120390OtherMEDICARE GROUP NUMBER
F25721Medicare UPIN
AZ120611Medicare PIN