Healthcare Provider Details

I. General information

NPI: 1922020023
Provider Name (Legal Business Name): BEVERLY M GENEZ M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/25/2006
Last Update Date: 02/15/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

636 G LONGPOINT RD #125
MOUNT PLEASANT SC
29464-7905
US

IV. Provider business mailing address

PO BOX 100523
FLORENCE SC
29501-0523
US

V. Phone/Fax

Practice location:
  • Phone: 843-352-0674
  • Fax: 843-971-3382
Mailing address:
  • Phone: 843-883-5010
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number14249
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: