Provider Demographics
NPI:1033116793
Name:BELOCURA, JONNALYN R (MD)
Entity type:Individual
Prefix:DR
First Name:JONNALYN
Middle Name:R
Last Name:BELOCURA
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 1:11345 MONTWOOD DR
Mailing Address - Street 2:SUITE A-1
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79936-3844
Mailing Address - Country:US
Mailing Address - Phone:915-921-5200
Mailing Address - Fax:915-921-5299
Practice Address - Street 1:11345 MONTWOOD DR
Practice Address - Street 2:SUITE A-1
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79936-3844
Practice Address - Country:US
Practice Address - Phone:915-921-5200
Practice Address - Fax:915-921-5299
Is Sole Proprietor?:No
Enumeration Date:2005-07-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL1268207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM000Z0453Medicaid
TX0022HBOtherBLUE CROSS BLUE SHIELD
TX0022HBOtherBLUE CROSS BLUE SHIELD
NM000Z0453Medicaid