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General NPI Number Information
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NPI Number | 1629174891
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Entity Type | Organization
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Legal Business Name | BEAUMONT FAMILY PRACTICE ASSOCIATES PA
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Dates
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Enumeration Date | 09/15/2006
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Last Update Date | 06/29/2016
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Provider Practice Location Address
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Address Line | 6450 FOLSOM
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City | BEAUMONT
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State | TX
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Zip | 77706
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Country | US
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Telephone | 409-835-0524
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Fax | 409-833-2058
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Provider Business Mailing Address
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Address Line | 6450 FOLSOM
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City | BEAUMONT
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State | TX
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Zip | 77706
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Country | US
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Telephone | 409-835-0524
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Fax | 409-833-2058
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Authorized Official
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Title or Position | PRESIDENT/OWNER
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Name | DR. JAY C PROCTOR III
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Credential | M.D.
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Telephone | 409-835-0524
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | F1914
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License Number State | TX
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