MEDICARE: MR. WAYNE LEE BEAVER MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RC0000X	Cardiovascular Disease Physician	35043307	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	000000216704	OTHER	OH	ANTHEM BCBS
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1184611170
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. WAYNE LEE BEAVER MD

Provider Business Mailing Address
First Line	:	777 W STATE ST
Second Line	:	SUITE 302
City	:	COLUMBUS
State	:	OH
Zip	:	43222-1536
Country	:	US
Telephone Number	:	614-221-2299
Fax Number	:	614-221-7458

Provider Business Practice Location Address
First Line	:	777 W STATE ST
Second Line	:	SUITE 302
City	:	COLUMBUS
State	:	OH
Zip	:	43222-1536
Country	:	US
Telephone Number	:	614-221-2299
Fax Number	:	614-221-7458

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/04/2005
Last Update Date	:	07/08/2007

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Directions to “ MR. WAYNE LEE BEAVER MD” Practice Location

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