MEDICARE: DR. STACY GERALD BEATY M.D.

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	207X00000X	Orthopaedic Surgery Physician	M3903	TX
2	207X00000X	Orthopaedic Surgery Physician	BP20019973	TX

General Provider Information

NPI Number	:	1457388589
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. STACY GERALD BEATY M.D.

Provider Business Mailing Address
First Line	:	4450 SUNSET DRIVE
Second Line	:
City	:	SAN ANGELO
State	:	TX
Zip	:	76901-5611
Country	:	US
Telephone Number	:	325-658-1511
Fax Number	:

Provider Business Practice Location Address
First Line	:	4450 SUNSET DRIVE
Second Line	:
City	:	SAN ANGELO
State	:	TX
Zip	:	76901-5611
Country	:	US
Telephone Number	:	325-658-1511
Fax Number	:

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

Provider Enumeration Date	:	06/26/2006
Last Update Date	:	04/11/2012

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