MEDICARE: GENEVIEVE M, BELGRAVE, M.D. PA

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	174400000X	Specialist	G7162	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1649200668	OTHER	TX	INDIVIDUAL NPI

General Provider Information

NPI Number	:	1043454648
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GENEVIEVE M, BELGRAVE, M.D. PA

Provider Business Mailing Address
First Line	:	7712 GRAND CANYON PL
Second Line	:
City	:	EL PASO
State	:	TX
Zip	:	79904-3140
Country	:	US
Telephone Number	:	915-204-0526
Fax Number	:	915-779-0440

Provider Business Practice Location Address
First Line	:	1316 N YARBROUGH DR
Second Line	:
City	:	EL PASO
State	:	TX
Zip	:	79925-7800
Country	:	US
Telephone Number	:	915-590-7378
Fax Number	:	915-590-7379

Authorized Official
Title or Position	:	OWNER
Name	:	GENEVIEVE M BELGRAVE
Credential	:	M.D.
Telephone Number	:	915-204-0526

Provider Enumeration Date	:	04/27/2009
Last Update Date	:	11/15/2022

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