Provider Demographics
NPI:1669531984
Name:BELT, THOMAS GLENN II (PA-C)
Entity type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:GLENN
Last Name:BELT
Suffix:II
Gender:M
Credentials:PA-C
Other - Prefix:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:327 FAIRMONT AVE
Mailing Address - Street 2:
Mailing Address - City:NEEDLES
Mailing Address - State:CA
Mailing Address - Zip Code:92363-2815
Mailing Address - Country:US
Mailing Address - Phone:760-326-0179
Mailing Address - Fax:
Practice Address - Street 1:1607 PLANTATION RD
Practice Address - Street 2:
Practice Address - City:MOHAVE VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:86440-9686
Practice Address - Country:US
Practice Address - Phone:928-346-4679
Practice Address - Fax:928-346-4686
Is Sole Proprietor?:No
Enumeration Date:2006-12-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZ3494363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical