Healthcare Provider Details

I. General information

NPI: 1033171269
Provider Name (Legal Business Name): MARK BELYEA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/04/2006
Last Update Date: 07/29/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

530 IOWA AVE SE
HURON SD
57350-2864
US

IV. Provider business mailing address

530 IOWA AVE SE
HURON SD
57350-2864
US

V. Phone/Fax

Practice location:
  • Phone: 605-352-6040
  • Fax: 605-352-6062
Mailing address:
  • Phone: 605-352-6040
  • Fax: 605-352-6062

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number1236
License Number StateSD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: