Provider Demographics
NPI:1487632865
Name:BETHEL, DENNIS (MD)
Entity Type:Individual
Prefix:
First Name:DENNIS
Middle Name:
Last Name:BETHEL
Suffix:
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 1:1303 E HERNDON AVE
Mailing Address - Street 2:SAINT AGNES MEDICAL CENTER
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93720-3309
Mailing Address - Country:US
Mailing Address - Phone:559-450-7055
Mailing Address - Fax:
Practice Address - Street 1:1303 E HERNDON AVE
Practice Address - Street 2:SAINT AGNES MEDICAL CENTER
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93720-3309
Practice Address - Country:US
Practice Address - Phone:559-450-7055
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-05
Last Update Date:2013-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM2002-0300207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM10003904OtherLOVELACE
AZ723470OtherAHCCCS
NM84355573Medicaid
NMPROVP11428OtherMOLINA
CA00A705220Medicaid
NM201037610OtherPRESBYTERIAN HEALTH/SALUD
NMNM007580OtherBC/BS
85031326887301A064OtherCHAMPUS
CA00A705220Medicaid
P00319727Medicare PIN
AZ723470OtherAHCCCS
NM84355573Medicaid
ZZZ34627ZMedicare PIN
NMNM007580OtherBC/BS