Provider Demographics
NPI:1255454286
Name:LAWRENCE W BENCE MD PC
Entity type:Organization
Organization Name:LAWRENCE W BENCE MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LAWRENCE
Authorized Official - Middle Name:W
Authorized Official - Last Name:BENCE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:520-868-5811
Mailing Address - Street 1:PO BOX 669
Mailing Address - Street 2:150 S MAIN ST
Mailing Address - City:FLORENCE
Mailing Address - State:AZ
Mailing Address - Zip Code:85132-3012
Mailing Address - Country:US
Mailing Address - Phone:520-868-5811
Mailing Address - Fax:520-868-1223
Practice Address - Street 1:150 S MAIN ST
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:AZ
Practice Address - Zip Code:85132-3012
Practice Address - Country:US
Practice Address - Phone:520-868-5811
Practice Address - Fax:520-868-1223
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-06
Last Update Date:2012-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ15656207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ1043275324OtherNPI LEE HOLLIDAY FNP
AZ1194713628OtherLAWRENCE W BENCE MD
AZZ72960Medicare ID - Type UnspecifiedLEE HOLLIDAY FNP
AZZ63982Medicare ID - Type UnspecifiedLAWREENCE W BENCE MD
AZP01984Medicare UPIN
AZ1043275324OtherNPI LEE HOLLIDAY FNP
AZD12945Medicare UPIN