Provider Demographics
NPI:1679683510
Name:LUCE, BETHANY L (MD)
Entity Type:Individual
Prefix:
First Name:BETHANY
Middle Name:L
Last Name:LUCE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:PO BOX 26568
Mailing Address - Street 2:
Mailing Address - City:PRESCOTT VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:86312-6568
Mailing Address - Country:US
Mailing Address - Phone:928-778-1251
Mailing Address - Fax:928-778-7834
Practice Address - Street 1:3251 N WINDSONG DR
Practice Address - Street 2:
Practice Address - City:PRESCOTT VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:86314-1222
Practice Address - Country:US
Practice Address - Phone:928-772-2582
Practice Address - Fax:928-772-2383
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2018-10-16
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
AZ32468207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ20-0641187OtherUNITED HEALTH
AZ20-0641187OtherAZ FOUNDATION
AZ869638OtherACCHS
AZAZ0749400OtherBLUE CROSS BLUE SHIELD
AZH32814Medicare UPIN