Individual
DR. RALPH C BETHEA III
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1235 E CHEROKEE ST, SPRINGFIELD, MO 65804-2203
(417) 820-2829
(417) 820-8852
Mailing address
PO BOX 2580, SPRINGFIELD, MO 65801-2580
(417) 829-4620
(417) 829-4316
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
2004003501
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
159212001
—
AR
01
—
175118
MO BLUE SHIELD
MO
05
—
209293117
—
MO
01
—
83131
ARK BLUE SHIELD
AR
Enumeration date
01/31/2007
Last updated
07/11/2008
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