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NPI Code Detail

MEDICARE: DR. BYRON KEVIN BEAVER M.D.

MEDICARE:  DR. BYRON KEVIN BEAVER  M.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
1207PE0005XUndersea and Hyperbaric Medicine (Emergency Medicine) PhysicianL6781TX
2207PE0005XUndersea and Hyperbaric Medicine (Emergency Medicine) PhysicianE-6065AR

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
4P00094736OTHERTXRAILROAD MEDICARE

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
28AJ534OTHERTXBCBS INDIVIDUAL
3MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1982688800
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. BYRON KEVIN BEAVER M.D.
Provider Business Mailing Address
First Line : PO BOX 16474
Second Line :
City : LITTLE ROCK
State : AR
Zip : 72231-6474
Country : US
Telephone Number : 501-202-3638
Fax Number : 501-202-3639
Provider Business Practice Location Address
First Line : 3333 SPRINGHILL DR
Second Line : SUITE 2002
City : NORTH LITTLE ROCK
State : AR
Zip : 72117-2922
Country : US
Telephone Number : 501-202-3638
Fax Number : 501-202-3639
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/05/2005
Last Update Date : 08/03/2011

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Directions to “ DR. BYRON KEVIN BEAVER M.D.” Practice Location

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