Healthcare Provider Details

I. General information

NPI: 1649200668
Provider Name (Legal Business Name): GENEVIEVE M BELGRAVE M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/04/2006
Last Update Date: 07/18/2024
Certification Date: 07/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1316 N YARBROUGH DR
EL PASO TX
79925-7800
US

IV. Provider business mailing address

7712 GRAND CANYON PL
EL PASO TX
79904-3140
US

V. Phone/Fax

Practice location:
  • Phone: 915-590-7378
  • Fax: 915-590-7379
Mailing address:
  • Phone: 915-533-8499
  • Fax: 915-544-4929

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberG7162
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License NumberG7162
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: