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General NPI Number Information
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NPI Number | 1972591030
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Entity Type | Individual
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Provider Name | THEODORE J BELTZ DO
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Gender | Male
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Dates
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Enumeration Date | 10/12/2005
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Last Update Date | 06/09/2014
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Provider Practice Location Address
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Address Line | 1765 COMMERCIAL ST
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City | WARSAW
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State | MO
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Zip | 65355-3096
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Country | US
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Telephone | 660-438-6800
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Fax | 660-438-6525
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Provider Business Mailing Address
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Address Line | 601 E 14TH ST P O BOX 1706
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City | SEDALIA
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State | MO
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Zip | 65301-5972
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Country | US
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Telephone | 866-678-5627
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Fax | 660-827-3742
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 110839
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License Number State | MO
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