Healthcare Provider Details

I. General information

NPI: 1063503449
Provider Name (Legal Business Name): MICHAEL H BELGARD PA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/28/2006
Last Update Date: 06/01/2023
Certification Date: 06/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

620 TENAHA ST
CENTER TX
75935-3404
US

IV. Provider business mailing address

620 TENAHA ST
CENTER TX
75935-3404
US

V. Phone/Fax

Practice location:
  • Phone: 936-598-2716
  • Fax: 936-598-5059
Mailing address:
  • Phone: 936-598-2716
  • Fax: 936-598-5059

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number00477
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: