Healthcare Provider Details

I. General information

NPI: 1063626018
Provider Name (Legal Business Name): LAWRENCE PRESANT D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/09/2007
Last Update Date: 08/02/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3805 E BELL RD STE 1600
PHOENIX AZ
85032-2105
US

IV. Provider business mailing address

18065 N THOMPSON PEAK PKWY APT 1016
SCOTTSDALE AZ
85255-6190
US

V. Phone/Fax

Practice location:
  • Phone: 480-945-0910
  • Fax: 480-391-8711
Mailing address:
  • Phone: 480-945-0910
  • Fax: 480-391-8711

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code202K00000X
TaxonomyPhlebology Physician
License Number3610
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: