=====================================================
General NPI Number Information
=====================================================
NPI Number | 1972724342
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ROSALYN BRIGETTE BEATY MD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/01/2007
-----------------------------------------------------
Last Update Date | 03/09/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 15003 FM 529 RD STE A-2
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77095-3247
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 281-463-9696
-----------------------------------------------------
Fax | 281-345-1994
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 126
-----------------------------------------------------
City | SUGAR LAND
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77487-0126
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 281-463-9696
-----------------------------------------------------
Fax | 281-345-1994
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2083X0100X
-----------------------------------------------------
Taxonomy Name | Occupational Medicine Physician
-----------------------------------------------------
License Number | K5806
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------