Healthcare Provider Details

I. General information

NPI: 1134385198
Provider Name (Legal Business Name): BEQUILLARD & BEQUILLARD LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/30/2008
Last Update Date: 05/08/2024
Certification Date: 05/08/2024
Deactivation Date: 10/22/2008
Reactivation Date: 12/03/2009

III. Provider practice location address

600 CUT OFF RD STE 14
PORT ARANSAS TX
78373-4246
US

IV. Provider business mailing address

600 CUT OFF RD SUITE 14
PORT ARANSAS TX
78373-4246
US

V. Phone/Fax

Practice location:
  • Phone: 361-749-1930
  • Fax: 361-749-1933
Mailing address:
  • Phone: 361-749-1930
  • Fax: 361-749-1933

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number207P00000X
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberG8391
License Number StateTX

VIII. Authorized Official

Name: AMBER BEQUILLARD
Title or Position: ADMINISTRATOR
Credential:
Phone: 361-749-1930