Doctor Name: | LAUREN AYRES BETHEA |
NPI Number: | 1265744437 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | M.D. |
License Number: | T-2287 |
Business Practice Address: | 421 S 28th Ave Suite 200 Hattiesburg, MS - 394017206 |
Business Phone Number: | 6012685640 |
Business Fax Number: | 6012613507 |
Mailing Address: | 415 S 28th Ave, HATTIESBURG |
State: | MS |
Postal Code: | 394017246 |
Phone Number: | 6015795463 |
Fax Number: | 6015795240 |
NPI Enumeration Date: | 07/05/2010 |
NPI Last Update Date: | 02/05/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 390200000X |
License Number: | T-2287 |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | MS |
Taxonomy Type: | Student, Health Care |
Taxonomy Classification: | Student in an Organized Health Care Education/Training Program |
Taxonomy Specialization: | |
Taxonomy Definition: | An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care. |