MEDICARE: GEORGE BEASLEY D.O.

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	207Q00000X	Family Medicine Physician	H7882	TX

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	080019357	OTHER		MEDICARE RAILROAD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	00F98H	OTHER	TX	BCBS
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1760499396
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GEORGE BEASLEY D.O.

Provider Business Mailing Address
First Line	:	PO BOX 121369
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76121-1369
Country	:	US
Telephone Number	:	817-377-1500
Fax Number	:	817-731-4272

Provider Business Practice Location Address
First Line	:	3256 LACKLAND RD
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76116-5307
Country	:	US
Telephone Number	:	817-377-1500
Fax Number	:	817-731-4272

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

Provider Enumeration Date	:	08/03/2006
Last Update Date	:	08/05/2010

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