Provider Demographics
NPI:1063503449
Name:BELGARD, MICHAEL H (PA)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:H
Last Name:BELGARD
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:620 TENAHA ST
Mailing Address - Street 2:
Mailing Address - City:CENTER
Mailing Address - State:TX
Mailing Address - Zip Code:75935-3404
Mailing Address - Country:US
Mailing Address - Phone:936-598-2716
Mailing Address - Fax:936-598-5059
Practice Address - Street 1:620 TENAHA ST
Practice Address - Street 2:
Practice Address - City:CENTER
Practice Address - State:TX
Practice Address - Zip Code:75935-3404
Practice Address - Country:US
Practice Address - Phone:936-598-2716
Practice Address - Fax:936-598-5059
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-28
Last Update Date:2023-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX00477363AM0700X
363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedicalGroup - Single Specialty