Provider Demographics
NPI:1407820517
Name:BANS, LARRY LOUIS (MD)
Entity Type:Individual
Prefix:DR
First Name:LARRY
Middle Name:LOUIS
Last Name:BANS
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 1:1 E CAMELBACK RD
Mailing Address - Street 2:SUITE 700
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85012-1668
Mailing Address - Country:US
Mailing Address - Phone:602-748-1100
Mailing Address - Fax:602-748-1101
Practice Address - Street 1:2525 E ARIZONA BILTMORE CIR
Practice Address - Street 2:SUITE C-236
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85016-2146
Practice Address - Country:US
Practice Address - Phone:602-426-9772
Practice Address - Fax:602-426-9775
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-15
Last Update Date:2014-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ13844208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ4060579OtherAETNA
AZ2975980OtherCIGNA
AZP01373999OtherRR MEDICARE
AZP01373999OtherRR MEDICARE
AZZ168693Medicare PIN