Provider Demographics
NPI:1194713628
Name:BENCE, LAWRENCE W (MD)
Entity type:Individual
Prefix:DR
First Name:LAWRENCE
Middle Name:W
Last Name:BENCE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:13416 N 32ND ST STE 109
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85032-6000
Mailing Address - Country:US
Mailing Address - Phone:480-428-3526
Mailing Address - Fax:480-428-4545
Practice Address - Street 1:13416 N 32ND ST STE 109
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85032-6000
Practice Address - Country:US
Practice Address - Phone:480-428-3526
Practice Address - Fax:480-428-4545
Is Sole Proprietor?:No
Enumeration Date:2005-10-10
Last Update Date:2020-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ15659207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ252833Medicaid
AZD12945Medicare UPIN
AZ63982Medicare ID - Type UnspecifiedMEDICARE