MEDICARE: DR. RICHARD BEAVER PH.D.

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	103TH0100X	Health Service Psychologist	20328	CA
2	103TH0100X	Health Service Psychologist	1565	CO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1487673596
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RICHARD BEAVER PH.D.

Provider Business Mailing Address
First Line	:	275 HOSPITAL PKWY
Second Line	:	SUITE 470
City	:	SAN JOSE
State	:	CA
Zip	:	95119-1106
Country	:	US
Telephone Number	:	408-972-3364
Fax Number	:	408-972-6088

Provider Business Practice Location Address
First Line	:	275 HOSPITAL PKWY
Second Line	:	SUITE 470
City	:	SAN JOSE
State	:	CA
Zip	:	95119-1106
Country	:	US
Telephone Number	:	408-972-3364
Fax Number	:	408-972-6088

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

Provider Enumeration Date	:	07/19/2006
Last Update Date	:	07/08/2007

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