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General NPI Number Information
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NPI Number | 1659364735
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Entity Type | Individual
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Provider Name | JAMES E BEAVER JR. PAC
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Gender | Male
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Dates
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Enumeration Date | 08/24/2005
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Last Update Date | 02/03/2010
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Provider Practice Location Address
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Address Line | 134 MEDICAL PL
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City | BEAVER
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State | WV
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Zip | 25813-8977
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Country | US
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Telephone | 304-255-1080
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Fax | 304-255-1082
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Provider Business Mailing Address
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Address Line | 208 DOGWOOD CT
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City | DANIELS
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State | WV
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Zip | 25832-9202
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Country | US
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Telephone | 304-763-5121
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Fax | 304-469-1518
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 779
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License Number State | WV
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