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1487632865

NPI Code Detail

MEDICARE: DENNIS BETHEL MD

MEDICARE: DENNIS BETHEL MD

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	207P00000X	Emergency Medicine Physician	2002-0300	NM

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	10003904	OTHER	NM	LOVELACE
2	723470	OTHER	AZ	AHCCCS
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	PROVP11428	OTHER	NM	MOLINA
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6	201037610	OTHER	NM	PRESBYTERIAN HEALTH/SALUD
7	NM007580	OTHER	NM	BC/BS
8	85031326887301A064	OTHER		CHAMPUS

General Provider Information

NPI Number	:	1487632865
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DENNIS BETHEL MD

Provider Business Mailing Address
First Line	:	1303 E HERNDON AVE
Second Line	:	SAINT AGNES MEDICAL CENTER
City	:	FRESNO
State	:	CA
Zip	:	93720-3309
Country	:	US
Telephone Number	:	559-450-7055
Fax Number	:

Provider Business Practice Location Address
First Line	:	1303 E HERNDON AVE
Second Line	:	SAINT AGNES MEDICAL CENTER
City	:	FRESNO
State	:	CA
Zip	:	93720-3309
Country	:	US
Telephone Number	:	559-450-7055
Fax Number	:

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

Provider Enumeration Date	:	01/05/2006
Last Update Date	:	11/07/2013

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Directions to “ DENNIS BETHEL MD” Practice Location

Language	Start Address	Practice Location

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