Individual
DR. MARK D BEALE I
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
133 WYATT DR, SUITE 9, LAS CRUCES, NM 88005-2962
(575) 680-2684
(575) 680-2655
Mailing address
133 WYATT DR, SUITE 9, LAS CRUCES, NM 88005-2962
(575) 680-2684
(575) 680-2655
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
93-208
NM
2084P2900X
Pain Medicine (Psychiatry & Neurology) Physician
93-208
NM
208VP0000X
Pain Medicine Physician
93-208
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1164547709
PSYCHIATRY/PAIN MANAGEMENT
NM
05
—
1164547709
—
NM
Enumeration date
03/20/2007
Last updated
02/22/2019
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