Individual
DR. MARK BEVAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
812 W MAPLE ST, FARMINGTON, NM 87401-5631
(505) 326-6521
(505) 325-6699
Mailing address
622 W MAPLE ST STE H, FARMINGTON, NM 87401-6589
(505) 326-6521
(505) 325-6699
Taxonomy
Speciality
Code
Description
License number
State
207RN0300X
Nephrology Physician
Primary
82-11
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
225442
—
AZ
05
—
23325
—
NM
05
—
91082115
—
CO
05
—
T0078
—
UT
Enumeration date
09/20/2006
Last updated
03/19/2020
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