Provider Demographics
NPI:1336597277
Name:BENTON, LAUREN DEANNA (MD)
Entity type:Individual
Prefix:MRS
First Name:LAUREN
Middle Name:DEANNA
Last Name:BENTON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:LAUREN
Other - Middle Name:D
Other - Last Name:KING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1501 N CAMPBELL AVE
Mailing Address - Street 2:P.O. BOX 245073
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85724-5073
Mailing Address - Country:US
Mailing Address - Phone:520-626-6507
Mailing Address - Fax:520-626-5652
Practice Address - Street 1:1501 N CAMPBELL AVE
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85724-5073
Practice Address - Country:US
Practice Address - Phone:520-626-6507
Practice Address - Fax:520-626-5652
Is Sole Proprietor?:No
Enumeration Date:2016-06-01
Last Update Date:2016-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZR75723208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics