MEDICARE: DR. CHARLES V BEALL

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	208600000X	Surgery Physician	H6039	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	122995	OTHER	TX	SUPERIOR/CHIPS
2	4523320	OTHER	TX	AETNA
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	83Y705	OTHER	TX	BCBS

General Provider Information

NPI Number	:	1457321853
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CHARLES V BEALL

Provider Business Mailing Address
First Line	:	PO BOX 846098
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75284-6098
Country	:	US
Telephone Number	:	903-324-6450
Fax Number	:

Provider Business Practice Location Address
First Line	:	910 E HOUSTON ST
Second Line	:	SUITE 550
City	:	TYLER
State	:	TX
Zip	:	75702-8369
Country	:	US
Telephone Number	:	903-592-7393
Fax Number	:	903-597-7538

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

Provider Enumeration Date	:	01/26/2006
Last Update Date	:	12/08/2014

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Directions to “ DR. CHARLES V BEALL ” Practice Location

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