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General NPI Number Information
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NPI Number | 1477842573
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Entity Type | Organization
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Legal Business Name | BEAVERS DERMATOLOGY & SKIN SURGERY, PLLC
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Dates
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Enumeration Date | 03/30/2011
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Last Update Date | 08/10/2023
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Provider Practice Location Address
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Address Line | 207 E MEADOW RD STE 1
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City | EDEN
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State | NC
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Zip | 27288-3469
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Country | US
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Telephone | 336-627-3194
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Fax | 336-627-3208
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Provider Business Mailing Address
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Address Line | PO BOX 1693
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City | BRYSON CITY
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State | NC
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Zip | 28713-1693
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Country | US
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Telephone | 336-967-0004
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Fax | 828-538-4441
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Authorized Official
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Title or Position | OWNER
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Name | DR. CLARENCE BEAVERS
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Credential | MD
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Telephone | 336-627-3194
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number | 39543
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License Number State | NC
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