MEDICARE: MR. THOMAS GLENN BELT II PA-C

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	363AM0700X	Medical Physician Assistant	3494	AZ

General Provider Information

NPI Number	:	1669531984
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. THOMAS GLENN BELT II PA-C

Provider Business Mailing Address
First Line	:	327 FAIRMONT AVE
Second Line	:
City	:	NEEDLES
State	:	CA
Zip	:	92363-2815
Country	:	US
Telephone Number	:	760-326-0179
Fax Number	:

Provider Business Practice Location Address
First Line	:	1607 PLANTATION RD
Second Line	:
City	:	MOHAVE VALLEY
State	:	AZ
Zip	:	86440-9686
Country	:	US
Telephone Number	:	928-346-4679
Fax Number	:	928-346-4686

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

Provider Enumeration Date	:	12/06/2006
Last Update Date	:	07/08/2007

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