Healthcare Provider Details

I. General information

NPI: 1619963105
Provider Name (Legal Business Name): JOSEPH HERMAN BEAVEN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/21/2005
Last Update Date: 02/21/2022
Certification Date: 02/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9431 COUNTY ROAD 403
CHARLESTOWN IN
47111-8946
US

IV. Provider business mailing address

9431 COUNTY ROAD 403
CHARLESTOWN IN
47111-8946
US

V. Phone/Fax

Practice location:
  • Phone: 812-256-6391
  • Fax: 812-256-6050
Mailing address:
  • Phone: 812-256-6391
  • Fax: 812-256-6050

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number01032564A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number01032564A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: