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General NPI Number Information
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NPI Number | 1669486692
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Entity Type | Individual
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Provider Name | BRENT D BEVARD DO
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Gender | Male
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Dates
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Enumeration Date | 07/27/2006
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Last Update Date | 03/25/2025
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Provider Practice Location Address
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Address Line | 1 LINCOLN PKWY STE 300
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City | HATTIESBURG
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State | MS
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Zip | 39402-3261
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Country | US
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Telephone | 601-261-1600
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Fax | 601-268-5819
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Provider Business Mailing Address
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Address Line | 415 S 28TH AVE
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City | HATTIESBURG
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State | MS
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Zip | 39401-7246
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Country | US
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Telephone | 601-261-1600
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Fax | 601-579-5240
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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 | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number | A-1167-01
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License Number State | NM
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Taxonomy #2
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number | 18004
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License Number State | MS
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Taxonomy #3
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Taxonomy Code | 2081P2900X
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Taxonomy Name | Pain Medicine (Physical Medicine & Rehabilitation) Physician
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License Number | 18004
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License Number State | MS
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