Healthcare Provider Details

I. General information

NPI: 1023283843
Provider Name (Legal Business Name): JACQUES DAVID BEVERIDGE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/23/2008
Last Update Date: 09/19/2026
Certification Date: 09/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3952 PARKVIEW DR
CHEYENNE WY
82001-8102
US

IV. Provider business mailing address

3952 PARKVIEW DR
CHEYENNE WY
82001-8102
US

V. Phone/Fax

Practice location:
  • Phone: 307-637-7700
  • Fax: 307-637-5672
Mailing address:
  • Phone: 307-637-7700
  • Fax: 307-637-5672

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberCDR.0006545
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number6275A
License Number StateWY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: