Basic Information
| Provider Information | |||||||||
| NPI: | 1902005234 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CORPUS | ||||||||
| FirstName: | MICHAEL | ||||||||
| MiddleName: | BELTRAN | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 321 MOCKINGBIRD LN | ||||||||
| Address2: | |||||||||
| City: | EL DORADO | ||||||||
| State: | AR | ||||||||
| PostalCode: | 717302837 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8708758838 | ||||||||
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| Practice Location | |||||||||
| Address1: | 460 W OAK ST | ||||||||
| Address2: | |||||||||
| City: | EL DORADO | ||||||||
| State: | AR | ||||||||
| PostalCode: | 717304567 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8708814478 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/17/2007 | ||||||||
| LastUpdateDate: | 07/01/2011 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 207Q00000X | E5778 | AR | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.