MEDICARE: BEAVERS DERMATOLOGY & SKIN SURGERY, PLLC

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	207N00000X	Dermatology Physician	39543	NC

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2154554C	OTHER	NC	MEDICARE
2	DR4608	OTHER	NC	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1477842573
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BEAVERS DERMATOLOGY & SKIN SURGERY, PLLC

Provider Business Mailing Address
First Line	:	PO BOX 1693
Second Line	:
City	:	BRYSON CITY
State	:	NC
Zip	:	28713-1693
Country	:	US
Telephone Number	:	336-967-0004
Fax Number	:	828-538-4441

Provider Business Practice Location Address
First Line	:	207 E MEADOW RD STE 1
Second Line	:
City	:	EDEN
State	:	NC
Zip	:	27288-3469
Country	:	US
Telephone Number	:	336-627-3194
Fax Number	:	336-627-3208

Authorized Official
Title or Position	:	OWNER
Name	:	DR. CLARENCE BEAVERS
Credential	:	MD
Telephone Number	:	336-627-3194

Provider Enumeration Date	:	03/30/2011
Last Update Date	:	08/10/2023

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1730578402 — JOE GRAY CARPENTER PT, DPT,OCS, FAAOMPT
Practice Location Address:

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