1801897640 NPI number — DR. BRUCE CHARLES BEGIA M.D.

Table of content: DR. BRUCE CHARLES BEGIA M.D. (NPI 1801897640)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1801897640 NPI number — DR. BRUCE CHARLES BEGIA M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BEGIA
Provider First Name:
BRUCE
Provider Middle Name:
CHARLES
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1801897640
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/09/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
124 E BANDERA RD STE 102
Provider Second Line Business Mailing Address:
WELLMED AT BOERNE
Provider Business Mailing Address City Name:
BOERNE
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78006
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
830-816-2312
Provider Business Mailing Address Fax Number:
830-816-2349

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
124 E BANDERA RD STE 102
Provider Second Line Business Practice Location Address:
WELLMED AT BOERNE
Provider Business Practice Location Address City Name:
BOERNE
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78006
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
830-816-2312
Provider Business Practice Location Address Fax Number:
830-816-2349
Provider Enumeration Date:
08/02/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  J3984 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 121278907 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 080120052 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 84220F . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 121278902 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: J3984 . This is a "TX LICENSE NUMBER" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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