Provider Demographics
NPI:1265660724
Name:BEDGOOD, ALYSIA MAE (MD)
Entity Type:Individual
Prefix:DR
First Name:ALYSIA
Middle Name:MAE
Last Name:BEDGOOD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:115 KOHLERS XING STE 200
Mailing Address - Street 2:
Mailing Address - City:KYLE
Mailing Address - State:TX
Mailing Address - Zip Code:78640-2461
Mailing Address - Country:US
Mailing Address - Phone:512-300-0970
Mailing Address - Fax:866-358-3313
Practice Address - Street 1:115 KOHLERS XING STE 200
Practice Address - Street 2:
Practice Address - City:KYLE
Practice Address - State:TX
Practice Address - Zip Code:78640-2461
Practice Address - Country:US
Practice Address - Phone:512-413-1402
Practice Address - Fax:866-358-3313
Is Sole Proprietor?:No
Enumeration Date:2009-06-23
Last Update Date:2019-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2018026857207Q00000X
IL036144190207Q00000X
MN64220207Q00000X
IAMD-44808207Q00000X
TXN9171207QS0010X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports Medicine