Healthcare Provider Details

I. General information

NPI: 1881833218
Provider Name (Legal Business Name): BEEVILLE INTERNISTS, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/09/2009
Last Update Date: 01/06/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

711 E HOUSTON ST
BEEVILLE TX
78102-5023
US

IV. Provider business mailing address

PO BOX 3808
CORPUS CHRISTI TX
78463-3808
US

V. Phone/Fax

Practice location:
  • Phone: 361-343-2258
  • Fax:
Mailing address:
  • Phone: 361-884-2904
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License NumberM2669
License Number StateTX

VIII. Authorized Official

Name: BEHRAM A KHAN
Title or Position: OWNER
Credential: MD
Phone: 361-343-2258