Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | 036144190 | IL |
N | 207Q00000X | Family Doctor | 2018026857 | MO |
N | 207Q00000X | Family Doctor | 64220 | MN |
N | 207Q00000X | Family Doctor | MD-44808 | IA |
Y | 207Q00000X | Family Doctor | N9171 | TX |
N | 207QS0010X | Family Doctor - Sports Medicine | N9171 | TX |
NPI | 1265660724 |
---|---|
Provider Name | Dr. Alysia Mae Bedgood |
First Address | Kyle, TX 78640-2461 |
Second Address | Kyle, TX 78640-2461 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/06/2009 |
Last Update Date | 13/08/2019 |