Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208D00000X | General Practice Physician | 34212 | NE |
NPI | 1043839764 |
---|---|
Provider Name | Lucien Reiter Mcbeth |
First Address | Jbsa Ft Sam Houston, TX 78234-4504 |
Second Address | Jbsa Ft Sam Houston, TX 78234-4504 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/04/2020 |
Last Update Date | 27/01/2022 |