MEDICARE: DR. LUIS GUILLERMO BEVERIDO M.D.

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	207R00000X	Internal Medicine Physician	GA75398	GA
2	207R00000X	Internal Medicine Physician	MD2024-0315	NM

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

General Provider Information

NPI Number	:	1699194985
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LUIS GUILLERMO BEVERIDO M.D.

Provider Business Mailing Address
First Line	:	3900 LAS ESTANCIAS CT SW
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87121-5513
Country	:	US
Telephone Number	:	505-727-4200
Fax Number	:

Provider Business Practice Location Address
First Line	:	3900 LAS ESTANCIAS CT SW
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87121-5513
Country	:	US
Telephone Number	:	505-727-4200
Fax Number	:

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

Provider Enumeration Date	:	04/15/2014
Last Update Date	:	04/08/2024

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Directions to “ DR. LUIS GUILLERMO BEVERIDO M.D.” Practice Location

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