Provider Demographics
NPI:1437348828
Name:NORTHERN ARIZONA UROLOGY
Entity Type:Organization
Organization Name:NORTHERN ARIZONA UROLOGY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:NATHAN
Authorized Official - Middle Name:A
Authorized Official - Last Name:BENSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:928-774-8201
Mailing Address - Street 1:1300 N RIM DR
Mailing Address - Street 2:SUITE C
Mailing Address - City:FLAGSTAFF
Mailing Address - State:AZ
Mailing Address - Zip Code:86001-3128
Mailing Address - Country:US
Mailing Address - Phone:928-779-6139
Mailing Address - Fax:
Practice Address - Street 1:1300 N RIM DR
Practice Address - Street 2:SUITE C
Practice Address - City:FLAGSTAFF
Practice Address - State:AZ
Practice Address - Zip Code:86001-3128
Practice Address - Country:US
Practice Address - Phone:928-779-6139
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-22
Last Update Date:2007-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ204777Medicaid
AZ976110Medicaid