Healthcare Provider Details

I. General information

NPI: 1710191853
Provider Name (Legal Business Name): LAWRENCE P PRESANT DO PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/09/2007
Last Update Date: 02/11/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20950 N TATUM BLVD STE 220
PHOENIX AZ
85050-4200
US

IV. Provider business mailing address

10348 N 99TH ST
SCOTTSDALE AZ
85258-4785
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: LAWRENCE PRESANT
Title or Position: PRESIDENT
Credential: D.O.
Phone: 480-945-0910