Provider Demographics
NPI:1003013566
Name:BENARD, MARC ALAN (DPM)
Entity Type:Individual
Prefix:
First Name:MARC
Middle Name:ALAN
Last Name:BENARD
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:3812 SEPULVEDA BLVD
Mailing Address - Street 2:SUITE 530
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90505-2413
Mailing Address - Country:US
Mailing Address - Phone:310-530-8001
Mailing Address - Fax:310-375-1386
Practice Address - Street 1:3812 SEPULVEDA BLVD
Practice Address - Street 2:SUITE 530
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90505-2413
Practice Address - Country:US
Practice Address - Phone:310-530-8001
Practice Address - Fax:310-375-1386
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAE2178213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
T11215Medicare UPIN
E2178Medicare ID - Type Unspecified