MEDICARE: BETH A BESAW MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	35075892	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	000000340015	OTHER	OH	ANTHEM
3	7656122	OTHER	OH	AETNA
4	2-95562	OTHER	OH	UHC
5	P00158158	OTHER	OH	RRMC
6	03593	OTHER	OH	PHC

General Provider Information

NPI Number	:	1013900950
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BETH A BESAW MD

Provider Business Mailing Address
First Line	:	1250 RALSTON AVE
Second Line	:	SUITE 104
City	:	DEFIANCE
State	:	OH
Zip	:	43512-5311
Country	:	US
Telephone Number	:	419-783-6995
Fax Number	:	419-784-1603

Provider Business Practice Location Address
First Line	:	1250 RALSTON AVE
Second Line	:	SUITE 104
City	:	DEFIANCE
State	:	OH
Zip	:	43512-5311
Country	:	US
Telephone Number	:	419-783-6995
Fax Number	:	419-784-1606

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/25/2005
Last Update Date	:	04/30/2012

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Directions to “ BETH A BESAW MD” Practice Location

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