Basic Information
| Provider Information | |||||||||
| NPI: | 1003013566 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BENARD | ||||||||
| FirstName: | MARC | ||||||||
| MiddleName: | ALAN | ||||||||
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| Credential: | DPM | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3812 SEPULVEDA BLVD | ||||||||
| Address2: | SUITE 530 | ||||||||
| City: | TORRANCE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 905052413 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3105308001 | ||||||||
| FaxNumber: | 3103751386 | ||||||||
| Practice Location | |||||||||
| Address1: | 3812 SEPULVEDA BLVD | ||||||||
| Address2: | SUITE 530 | ||||||||
| City: | TORRANCE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 905052413 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3105308001 | ||||||||
| FaxNumber: | 3103751386 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/28/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 213ES0103X | E2178 | CA | Y | Podiatric Medicine & Surgery Service Providers | Podiatrist | Foot & Ankle Surgery |
No ID Information.