Provider Demographics
NPI:1750470282
Name:LAGMAN-BELTRAN, MARY GRACE (MD)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:GRACE
Last Name:LAGMAN-BELTRAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:GRACE
Other - Last Name:LAGMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:315 MARTIN LUTHER KING JR WAY
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98405-4234
Mailing Address - Country:US
Mailing Address - Phone:253-403-1291
Mailing Address - Fax:253-403-1374
Practice Address - Street 1:315 MARTIN LUTHER KING JR WAY
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98405-4234
Practice Address - Country:US
Practice Address - Phone:253-403-1291
Practice Address - Fax:253-403-1374
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2013-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD60126222207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
P00379259OtherRAIL ROAD MEDICARE
320800OtherAMERIGROUP
OH000000507734OtherBCBS
000000508358OtherBCBS CLARK COUNTY
OH2690315Medicaid
P00379259OtherRAIL ROAD MEDICARE
LA4195951Medicare PIN
I63597Medicare UPIN