Provider Demographics
NPI:1134139652
Name:BEGUIN, EVERETT ALLEN III (MD)
Entity Type:Individual
Prefix:
First Name:EVERETT
Middle Name:ALLEN
Last Name:BEGUIN
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:855 MANKATO AVE
Mailing Address - Street 2:WINONA HEALTH SERVICES
Mailing Address - City:WINONA
Mailing Address - State:MN
Mailing Address - Zip Code:55987-4868
Mailing Address - Country:US
Mailing Address - Phone:507-454-3680
Mailing Address - Fax:507-457-7672
Practice Address - Street 1:855 MANKATO AVE
Practice Address - Street 2:WINONA HEALTH SERVICES
Practice Address - City:WINONA
Practice Address - State:MN
Practice Address - Zip Code:55987-4868
Practice Address - Country:US
Practice Address - Phone:507-454-3680
Practice Address - Fax:507-457-7672
Is Sole Proprietor?:No
Enumeration Date:2006-08-08
Last Update Date:2011-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN47171207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN006620600Medicaid
H09682Medicare UPIN
MN006620600Medicaid