Provider Demographics
NPI:1902978950
Name:WALENDA, BEATA (MD)
Entity Type:Individual
Prefix:
First Name:BEATA
Middle Name:
Last Name:WALENDA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2379 GUS THOMASSON RD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:MESQUITE
Mailing Address - State:TX
Mailing Address - Zip Code:75150-5302
Mailing Address - Country:US
Mailing Address - Phone:972-613-3700
Mailing Address - Fax:972-613-3700
Practice Address - Street 1:2379 GUS THOMASSON RD
Practice Address - Street 2:SUITE 300
Practice Address - City:MESQUITE
Practice Address - State:TX
Practice Address - Zip Code:75150-5302
Practice Address - Country:US
Practice Address - Phone:972-613-3700
Practice Address - Fax:972-613-3700
Is Sole Proprietor?:No
Enumeration Date:2006-11-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ9426207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8U9341OtherBCBS
G31357Medicare UPIN
TX8F2699Medicare ID - Type Unspecified