MEDICARE: DAVID J BEARE PHD

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	103T00000X	Psychologist	021P	AR

Other Identifiers

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

General Provider Information

NPI Number	:	1609863562
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAVID J BEARE PHD

Provider Business Mailing Address
First Line	:	PO BOX 402330
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30384-2330
Country	:	US
Telephone Number	:	479-709-7399
Fax Number	:	479-709-7053

Provider Business Practice Location Address
First Line	:	1500 DODSON AVE
Second Line	:	STE 240
City	:	FORT SMITH
State	:	AR
Zip	:	72901-5182
Country	:	US
Telephone Number	:	479-709-7455
Fax Number	:	479-709-7456

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

Provider Enumeration Date	:	10/05/2005
Last Update Date	:	08/13/2010

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Directions to “ DAVID J BEARE PHD” Practice Location

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