Provider Demographics
NPI:1346286325
Name:BENEZE, NATHAN ERIC (MD)
Entity Type:Individual
Prefix:
First Name:NATHAN
Middle Name:ERIC
Last Name:BENEZE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2500 CANYON RD STE A1
Mailing Address - Street 2:
Mailing Address - City:BULLHEAD CITY
Mailing Address - State:AZ
Mailing Address - Zip Code:86442-8492
Mailing Address - Country:US
Mailing Address - Phone:928-704-4499
Mailing Address - Fax:928-704-4949
Practice Address - Street 1:2500 CANYON RD STE A1
Practice Address - Street 2:
Practice Address - City:BULLHEAD CITY
Practice Address - State:AZ
Practice Address - Zip Code:86442-8492
Practice Address - Country:US
Practice Address - Phone:928-704-4499
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-20
Last Update Date:2023-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ14102207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZE80456Medicare UPIN
AZ62741Medicare ID - Type UnspecifiedBENEZE BILLING NUM