MEDICARE: ROBERT BOYD BEAU CAULDER AGPCNP-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208D00000X	General Practice Physician	0024185627	VA

General Provider Information

NPI Number	:	1356050306
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROBERT BOYD BEAU CAULDER AGPCNP-C

Provider Business Mailing Address
First Line	:	3645 VAN BUREN DR
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23452-3140
Country	:	US
Telephone Number	:	757-802-1891
Fax Number	:

Provider Business Practice Location Address
First Line	:	3645 VAN BUREN DR
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23452-3140
Country	:	US
Telephone Number	:	757-802-1891
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/18/2022
Last Update Date	:	11/18/2022

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