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General NPI Number Information
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NPI Number | 1033520192
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Entity Type | Individual
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Provider Name | MICHAEL DEBOER D.O
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Gender | Male
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Dates
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Enumeration Date | 05/12/2014
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Last Update Date | 01/08/2020
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Provider Practice Location Address
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Address Line | 3269 N STOCKTON HILL RD
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City | KINGMAN
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State | AZ
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Zip | 86409-3619
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Country | US
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Telephone | 702-222-4307
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Fax |
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Provider Business Mailing Address
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Address Line | 6980 MOUNTAIN MOSS DR
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City | LAS VEGAS
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State | NV
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Zip | 89147-3815
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Country | US
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Telephone | 702-222-4307
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 007293
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License Number State | AZ
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