Healthcare Provider Details

I. General information

NPI: 1417958869
Provider Name (Legal Business Name): HILARY A BEAVER MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/09/2005
Last Update Date: 06/28/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6560 FANNIN ST SUITE 450
HOUSTON TX
77030-2761
US

IV. Provider business mailing address

6560 FANNIN ST SUITE 450
HOUSTON TX
77030-2761
US

V. Phone/Fax

Practice location:
  • Phone: 713-441-8843
  • Fax: 713-441-6463
Mailing address:
  • Phone: 713-441-8843
  • Fax: 713-441-6463

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number33313
License Number StateIA
# 2
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberJ8201
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: