Basic Information
Provider Information
NPI: 1164561163
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: BEGAY
FirstName: BETH
MiddleName: J
NamePrefix:  
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 5400 GIBSON BLVD SE
Address2:  
City: ALBUQUERQUE
State: NM
PostalCode: 871084729
CountryCode: US
TelephoneNumber: 5052627960
FaxNumber: 5052321368
Practice Location
Address1: 500 WALTER ST NE
Address2: SUITE 309
City: ALBUQUERQUE
State: NM
PostalCode: 871022534
CountryCode: US
TelephoneNumber: 5052623542
FaxNumber: 5052627394
Other Information
ProviderEnumerationDate: 02/06/2007
LastUpdateDate: 02/21/2013
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207R00000X2004-0809NMY Allopathic & Osteopathic PhysiciansInternal Medicine 

No ID Information.


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