Provider Demographics
NPI:1457331530
Name:BELDEN, JOHN M (DO)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:M
Last Name:BELDEN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:320 N 32ND AVE
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85009
Mailing Address - Country:US
Mailing Address - Phone:602-278-1351
Mailing Address - Fax:602-278-4057
Practice Address - Street 1:320 N 32ND AVE
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85009
Practice Address - Country:US
Practice Address - Phone:602-278-1351
Practice Address - Fax:602-278-4057
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-17
Last Update Date:2010-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ1645207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ250605Medicaid
D01645Medicare UPIN
AZ250605Medicaid