MEDICARE: GLEN A BEEDE DPM PA

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	261QP1100X	Podiatric Clinic/Center	1317	TX

General Provider Information

NPI Number	:	1407033400
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GLEN A BEEDE DPM PA

Provider Business Mailing Address
First Line	:	5521 BELLAIRE DR S STE 116
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76109-5855
Country	:	US
Telephone Number	:	817-763-9383
Fax Number	:	817-763-9385

Provider Business Practice Location Address
First Line	:	5521 BELLAIRE DR S STE 116
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76109-5855
Country	:	US
Telephone Number	:	817-763-9383
Fax Number	:	817-763-9385

Authorized Official
Title or Position	:	OWNER
Name	:	GLEN ALAN BEEDE
Credential	:	DPM
Telephone Number	:	817-763-9383

Provider Enumeration Date	:	01/22/2008
Last Update Date	:	12/22/2009

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Directions to “GLEN A BEEDE DPM PA ” Practice Location

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