=====================================================
General NPI Number Information
=====================================================
NPI Number | 1902913387
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CARLOS J BELMAR M.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/23/2006
-----------------------------------------------------
Last Update Date | 08/18/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1725 N 5TH ST
-----------------------------------------------------
City | TERRE HAUTE
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 47804-4010
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 812-242-3005
-----------------------------------------------------
Fax | 812-242-3054
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 221 S 6TH ST
-----------------------------------------------------
City | TERRE HAUTE
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 47807-4214
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 812-242-3005
-----------------------------------------------------
Fax | 812-242-3054
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207X00000X
-----------------------------------------------------
Taxonomy Name | Orthopaedic Surgery Physician
-----------------------------------------------------
License Number | 01047399A
-----------------------------------------------------
License Number State | IN
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207X00000X
-----------------------------------------------------
Taxonomy Name | Orthopaedic Surgery Physician
-----------------------------------------------------
License Number | 36099107
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------