Healthcare Provider Details

I. General information

NPI: 1245870427
Provider Name (Legal Business Name): ERIC HONAKER PA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/15/2020
Last Update Date: 04/27/2021
Certification Date: 04/27/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18555 N 79TH AVE STE D101
GLENDALE AZ
85308-6040
US

IV. Provider business mailing address

PO BOX 6408
SCOTTSDALE AZ
85261-6408
US

V. Phone/Fax

Practice location:
  • Phone: 480-563-6400
  • Fax: 480-563-8009
Mailing address:
  • Phone: 480-563-6400
  • Fax: 480-563-8009

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number8005
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: