Provider Demographics
NPI:1811044126
Name:BELTRAN, JESUS III (MD,PA)
Entity Type:Individual
Prefix:DR
First Name:JESUS
Middle Name:
Last Name:BELTRAN
Suffix:III
Gender:M
Credentials:MD,PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11605 SPRING CYPRESS RD
Mailing Address - Street 2:UNIT A
Mailing Address - City:TOMBALL
Mailing Address - State:TX
Mailing Address - Zip Code:77377-8915
Mailing Address - Country:US
Mailing Address - Phone:281-357-1890
Mailing Address - Fax:281-351-5032
Practice Address - Street 1:11605 SPRING CYPRESS RD
Practice Address - Street 2:UNIT A
Practice Address - City:TOMBALL
Practice Address - State:TX
Practice Address - Zip Code:77377-8915
Practice Address - Country:US
Practice Address - Phone:281-357-1890
Practice Address - Fax:281-351-5032
Is Sole Proprietor?:No
Enumeration Date:2007-01-05
Last Update Date:2010-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ6831207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0063DHOtherBCBS PROVIDER NO.
TX135189206Medicaid
TX760596382OtherTAX ID
TX0063DHOtherBCBS PROVIDER NO.
TXF85027Medicare UPIN