Healthcare Provider Details

I. General information

NPI: 1306377510
Provider Name (Legal Business Name): ALEXANDRA VIRGINIA BEQUER M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/21/2017
Last Update Date: 06/16/2020
Certification Date: 06/16/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 AUDUBON PLAZA DR
LOUISVILLE KY
40217-1318
US

IV. Provider business mailing address

PO BOX 36218
LOUISVILLE KY
40233-6218
US

V. Phone/Fax

Practice location:
  • Phone: 502-634-6767
  • Fax:
Mailing address:
  • Phone: 502-634-6767
  • Fax: 502-634-6775

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number52977
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: