1588705214 NPI number — MR. DAVID S BONE PA C

Table of content: MR. DAVID S BONE PA C (NPI 1588705214)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1588705214 NPI number — MR. DAVID S BONE PA C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BONE
Provider First Name:
DAVID
Provider Middle Name:
S
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
PA C
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1588705214
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/21/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5000 W CHANDLER BLVD BLDG CH-3
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHANDLER
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85226-3601
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
480-554-2323
Provider Business Mailing Address Fax Number:
480-552-7871

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5000 W CHANDLER BLVD BLDG CH-3
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CHANDLER
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85226-3601
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
480-554-2323
Provider Business Practice Location Address Fax Number:
480-552-7871
Provider Enumeration Date:
02/08/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363AM0700X , with the licence number:  3290 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 20-8823921 . This is a "TAX ID#" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com