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General NPI Number Information
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NPI Number | 1932568243
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Entity Type | Individual
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Provider Name | JEFFREY DAVID BEAL PA-C
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Gender | Male
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Dates
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Enumeration Date | 02/15/2016
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Last Update Date | 04/08/2016
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Provider Practice Location Address
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Address Line | 6720 BERTNER AVE
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City | HOUSTON
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State | TX
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Zip | 77030-2604
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Country | US
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Telephone | 832-355-9930
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Fax | 832-355-9931
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Provider Business Mailing Address
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Address Line | 7550 KIRBY DR APT 521
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City | HOUSTON
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State | TX
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Zip | 77030-4368
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Country | US
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Telephone | 801-809-8908
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Fax | 801-809-8901
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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 | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number | PA10499
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License Number State | TX
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