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General NPI Number Information
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NPI Number | 1700138799
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Entity Type | Individual
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Provider Name | JOHN ANDREW BEVERLIN PA-C
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Gender | Male
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Dates
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Enumeration Date | 10/15/2012
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Last Update Date | 05/13/2013
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Provider Practice Location Address
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Address Line | 211 HIGHLAND CROSS DR STE 275
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City | HOUSTON
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State | TX
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Zip | 77073-1741
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Country | US
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Telephone | 281-784-3203
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Fax |
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Provider Business Mailing Address
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Address Line | 2138 FENWOOD ST
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City | KEMAH
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State | TX
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Zip | 77565-2116
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Country | US
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Telephone | 713-922-4482
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Fax |
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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 | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA08033
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License Number State | TX
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