MEDICARE: DR. LARRY LOUIS BANS M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208800000X	Urology Physician	13844	AZ

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	P01373999	OTHER	AZ	RR MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	4060579	OTHER	AZ	AETNA
2	2975980	OTHER	AZ	CIGNA

General Provider Information

NPI Number	:	1407820517
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LARRY LOUIS BANS M.D.

Provider Business Mailing Address
First Line	:	1 E CAMELBACK RD
Second Line	:	SUITE 700
City	:	PHOENIX
State	:	AZ
Zip	:	85012-1668
Country	:	US
Telephone Number	:	602-748-1100
Fax Number	:	602-748-1101

Provider Business Practice Location Address
First Line	:	2525 E ARIZONA BILTMORE CIR
Second Line	:	SUITE C-236
City	:	PHOENIX
State	:	AZ
Zip	:	85016-2146
Country	:	US
Telephone Number	:	602-426-9772
Fax Number	:	602-426-9775

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/15/2006
Last Update Date	:	12/11/2014

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