Provider Demographics
NPI:1578587390
Name:BETTINGER, LAWRENCE A (MD)
Entity Type:Individual
Prefix:DR
First Name:LAWRENCE
Middle Name:A
Last Name:BETTINGER
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 1:13640 N 99TH AVE STE 600
Mailing Address - Street 2:
Mailing Address - City:SUN CITY
Mailing Address - State:AZ
Mailing Address - Zip Code:85351-2861
Mailing Address - Country:US
Mailing Address - Phone:623-972-2116
Mailing Address - Fax:623-972-0521
Practice Address - Street 1:13640 N 99TH AVE STE 600
Practice Address - Street 2:
Practice Address - City:SUN CITY
Practice Address - State:AZ
Practice Address - Zip Code:85351-2861
Practice Address - Country:US
Practice Address - Phone:623-972-2116
Practice Address - Fax:623-972-0521
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2013-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ15151174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZD36563Medicare UPIN