Provider Demographics
NPI:1023011269
Name:DECENA, BENIGNO F III (MD)
Entity Type:Individual
Prefix:
First Name:BENIGNO
Middle Name:F
Last Name:DECENA
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3709 N CAMPBELL AVE STE 201
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85719-1563
Mailing Address - Country:US
Mailing Address - Phone:520-838-2138
Mailing Address - Fax:520-624-2798
Practice Address - Street 1:4729 E CAMP LOWELL DR
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85712-1256
Practice Address - Country:US
Practice Address - Phone:520-838-3540
Practice Address - Fax:520-325-3526
Is Sole Proprietor?:Yes
Enumeration Date:2005-05-23
Last Update Date:2018-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ32303207RC0000X, 207RC0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0001XAllopathic & Osteopathic PhysiciansInternal MedicineClinical Cardiac Electrophysiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ2198100OtherGHI
AZ2Z0331OtherHEALTH NET
AZ830340Medicaid
AZ2079115OtherFIRST HEALTH
AZP00084839OtherRAILROAD MEDICARE
AZ5427615OtherCCN
AZ7597308OtherAETNA
AZ886331OtherUSA MANAGED CARE ORGANIZA
AZAZ0743710OtherBCBS OF ARIZONA
AZP00084839OtherRAILROAD MEDICARE
AZH46180Medicare UPIN
AZAZ0743710OtherBCBS OF ARIZONA