Provider Demographics
NPI:1639103047
Name:BELVIN, BRENT B (MD)
Entity Type:Individual
Prefix:
First Name:BRENT
Middle Name:B
Last Name:BELVIN
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 1:1101 RAINTREE CIR STE 240
Mailing Address - Street 2:
Mailing Address - City:ALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:75013-4926
Mailing Address - Country:US
Mailing Address - Phone:214-383-9270
Mailing Address - Fax:214-383-9271
Practice Address - Street 1:1101 RAINTREE CIR
Practice Address - Street 2:SUITE 240
Practice Address - City:ALLEN
Practice Address - State:TX
Practice Address - Zip Code:75013-4922
Practice Address - Country:US
Practice Address - Phone:214-383-9270
Practice Address - Fax:214-383-9271
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-10
Last Update Date:2015-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL2799208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX164068-07Medicaid
8CT918OtherBCBS
TX0013XGOtherBCBS
TX164068-07Medicaid
TXTXB147575Medicare PIN
TXTXB127657Medicare PIN