Provider Demographics
NPI:1750887782
Name:BELTRAN, SETH MICHAEL
Entity type:Individual
Prefix:
First Name:SETH
Middle Name:MICHAEL
Last Name:BELTRAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2727 EXPOSITION BLVD STE 105
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78703-1227
Mailing Address - Country:US
Mailing Address - Phone:512-478-6419
Mailing Address - Fax:
Practice Address - Street 1:2727 EXPOSITION BLVD STE 105
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78703-1227
Practice Address - Country:US
Practice Address - Phone:512-478-6419
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-30
Last Update Date:2021-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX68317183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX33997OtherUNIVERSITY OF TEXAS AT AUSTIN