Provider Demographics
NPI:1174502074
Name:BEJAR, MYRNA Y (PA)
Entity type:Individual
Prefix:
First Name:MYRNA
Middle Name:Y
Last Name:BEJAR
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5652 N MESA ST
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79912-5425
Mailing Address - Country:US
Mailing Address - Phone:915-351-1155
Mailing Address - Fax:915-351-1230
Practice Address - Street 1:5652 N MESA ST
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79912-5425
Practice Address - Country:US
Practice Address - Phone:915-351-1155
Practice Address - Fax:915-351-1230
Is Sole Proprietor?:No
Enumeration Date:2006-01-10
Last Update Date:2014-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA04168363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX126539901Medicaid
TX126539901Medicaid
P65869Medicare UPIN