Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223G0001X | General Practice | 1393 | NM |
Y | 213EG0000X | General Practice | 1393 | NM |
NPI | 1003943812 |
---|---|
Provider Name | Dr. Dorothy Lucille Beatty |
First Address | Santa Fe, NM 87508-8242 |
Second Address | Santa Fe, NM 87505-4785 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/02/2007 |
Last Update Date | 08/07/2007 |