Healthcare Provider Details

I. General information

NPI: 1255072138
Provider Name (Legal Business Name): MATTHEW BENJAMIN LANCASTER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/05/2022
Last Update Date: 10/14/2025
Certification Date: 10/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1300 N 12TH ST STE 508
PHOENIX AZ
85006-2849
US

IV. Provider business mailing address

406 S 4TH ST APT 407
BOISE ID
83702-7693
US

V. Phone/Fax

Practice location:
  • Phone: 602-839-3927
  • Fax: 602-839-4233
Mailing address:
  • Phone: 864-387-9382
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number4871752
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: