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General NPI Number Information
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NPI Number | 1891976171
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Entity Type | Organization
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Legal Business Name | BEAUMONT PLASTIC SURGERY ASSOCIATES, P.A.
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Dates
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Enumeration Date | 11/15/2007
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Last Update Date | 11/15/2007
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Provider Practice Location Address
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Address Line | 755 N 11TH ST SUITE P3500
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City | BEAUMONT
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State | TX
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Zip | 77702-1500
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Country | US
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Telephone | 409-892-6015
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Fax | 409-899-1338
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Provider Business Mailing Address
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Address Line | 755 N 11TH ST SUITE P3500
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City | BEAUMONT
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State | TX
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Zip | 77702-1500
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Country | US
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Telephone | 409-892-6015
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Fax | 409-899-1338
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. BENJAMIN WALLACE BECKERT
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Credential | M.D.
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Telephone | 409-892-6015
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208200000X
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Taxonomy Name | Plastic Surgery Physician
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License Number | L9621
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License Number State | TX
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