Provider Demographics
NPI:1033229406
Name:LAINE, BETH MARIE (MD)
Entity Type:Individual
Prefix:DR
First Name:BETH
Middle Name:MARIE
Last Name:LAINE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7630 BRENT LN
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89131-1712
Mailing Address - Country:US
Mailing Address - Phone:702-274-5774
Mailing Address - Fax:
Practice Address - Street 1:901 RANCHO LN
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89106-3836
Practice Address - Country:US
Practice Address - Phone:702-636-6370
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV6941207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
F35531Medicare UPIN