Provider Demographics
NPI:1336554070
Name:BECHTOLD, LANCE LEE (MD)
Entity type:Individual
Prefix:
First Name:LANCE
Middle Name:LEE
Last Name:BECHTOLD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:3333 E CAMELBACK RD STE 180
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85018-2396
Mailing Address - Country:US
Mailing Address - Phone:602-759-6883
Mailing Address - Fax:
Practice Address - Street 1:1520 S DOBSON RD STE 304
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85202-4727
Practice Address - Country:US
Practice Address - Phone:480-899-0767
Practice Address - Fax:480-899-1145
Is Sole Proprietor?:No
Enumeration Date:2014-06-20
Last Update Date:2024-08-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZ58269207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ517932Medicaid