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General NPI Number Information
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NPI Number | 1497200935
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Entity Type | Organization
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Legal Business Name | ANDREW D BEATY MD PA
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Dates
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Enumeration Date | 08/24/2016
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Last Update Date | 06/03/2020
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Provider Practice Location Address
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Address Line | 4200 S HULEN ST STE 230
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City | FORT WORTH
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State | TX
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Zip | 76109-4924
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Country | US
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Telephone | 817-315-2550
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Fax | 817-732-4660
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Provider Business Mailing Address
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Address Line | 4200 S HULEN ST STE 230
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City | FORT WORTH
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State | TX
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Zip | 76109-4924
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Country | US
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Telephone | 817-315-2550
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Fax | 817-732-4660
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Authorized Official
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Title or Position | PRESIDENT
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Name | ANDREW D BEATY
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Credential | MD
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Telephone | 817-315-2550
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2080P0201X
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Taxonomy Name | Pediatric Allergy/Immunology Physician
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License Number |
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 207K00000X
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Taxonomy Name | Allergy & Immunology Physician
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License Number |
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License Number State | TX
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Taxonomy #3
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Taxonomy Code | 207RA0201X
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Taxonomy Name | Allergy & Immunology (Internal Medicine) Physician
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License Number |
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License Number State | TX
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Taxonomy #4
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Taxonomy Code | 207KA0200X
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Taxonomy Name | Allergy Physician
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License Number |
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License Number State | TX
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