=====================================================
General NPI Number Information
=====================================================
NPI Number | 1023090024
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | TERRY JACKMAN BEAL M.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/16/2005
-----------------------------------------------------
Last Update Date | 07/30/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2117 S CLEAR CREEK RD
-----------------------------------------------------
City | KILLEEN
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 76549-4110
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 254-526-0188
-----------------------------------------------------
Fax | 254-200-4090
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 938
-----------------------------------------------------
City | KILLEEN
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 76540-0938
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 254-634-6999
-----------------------------------------------------
Fax | 254-200-4099
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207X00000X
-----------------------------------------------------
Taxonomy Name | Orthopaedic Surgery Physician
-----------------------------------------------------
License Number | F3403
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------