1447220678 NPI number — DR. DANIEL L BANGART DPM

Table of content: DR. DANIEL L BANGART DPM (NPI 1447220678)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1447220678 NPI number — DR. DANIEL L BANGART DPM

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BANGART
Provider First Name:
DANIEL
Provider Middle Name:
L
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DPM
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
BANGART
Provider Other First Name:
DANIEL
Provider Other Middle Name:
L
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
DPM
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1447220678
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/27/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
13660 N 94TH DR
Provider Second Line Business Mailing Address:
STE F1
Provider Business Mailing Address City Name:
PEORIA
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85381-4232
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
623-974-0522
Provider Business Mailing Address Fax Number:
623-933-5787

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
13660 N 94TH DR
Provider Second Line Business Practice Location Address:
STE F1
Provider Business Practice Location Address City Name:
PEORIA
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85381-4232
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
623-974-0522
Provider Business Practice Location Address Fax Number:
623-933-5787
Provider Enumeration Date:
01/23/2006

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: 213E00000X , with the licence number:  345 , 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: 480026137 . This is a "MEDICARE RAILROAD" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: 186206 . This is a "AHCCCS" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: 5059650001 . This is a "MEDICARE NSC" identifier . This identifiers is of the category "OTHER".
  • Identifier: AZ0190790 . This is a "BLUE CROSS" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".




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