Individual
STANISLAV V BELYAEV
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
603 W COUNTRY CLUB RD, ROSWELL, NM 88201-5211
(575) 624-5624
(575) 622-4279
Mailing address
603 W COUNTRY CLUB RD, ROSWELL, NM 88201-5211
(575) 624-5624
(575) 622-4279
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
2003-0691
NM
207RC0200X
Critical Care Medicine (Internal Medicine) Physician
MD2003-0691
NM
207RP1001X
Pulmonary Disease Physician
Primary
MD2003-0691
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
16500075
—
NM
01
—
324241YPPR
MEDICARE PTAN
NM
01
—
780148
MEDICARE PTAN / ROSWELL CLINIC CORP
NM
Enumeration date
09/29/2005
Last updated
09/14/2020
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