Healthcare Provider Details

I. General information

NPI: 1215930862
Provider Name (Legal Business Name): KLEE S BETHEL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/27/2005
Last Update Date: 03/09/2020
Certification Date: 03/09/2020
Deactivation Date: 03/17/2006
Reactivation Date: 03/31/2006

III. Provider practice location address

2152 E BROADWAY RD SUITE 1
TEMPE AZ
85282-1751
US

IV. Provider business mailing address

PO BOX 3490
APACHE JUNCTION AZ
85117-4126
US

V. Phone/Fax

Practice location:
  • Phone: 480-892-5313
  • Fax: 480-545-2788
Mailing address:
  • Phone: 480-892-5313
  • Fax: 480-545-2788

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number18441
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: