Healthcare Provider Details

I. General information

NPI: 1154140580
Provider Name (Legal Business Name): MICHAEL BEUG RN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/03/2024
Last Update Date: 10/03/2024
Certification Date: 10/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7400 MERTON MINTER ST RM B327
SAN ANTONIO TX
78229-4404
US

IV. Provider business mailing address

7400 MERTON MINTER ST RM B327
SAN ANTONIO TX
78229-4404
US

V. Phone/Fax

Practice location:
  • Phone: 210-617-5108
  • Fax:
Mailing address:
  • Phone: 210-617-5108
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WI0600X
TaxonomyInfection Control Registered Nurse
License Number823592
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: