MEDICARE: BEAUFORD BASPED JR DO 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	207Q00000X	Family Medicine Physician

General Provider Information

NPI Number	:	1801513437
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BEAUFORD BASPED JR DO PLLC

Provider Business Mailing Address
First Line	:	7510 HUDSON CEMETERY RD
Second Line	:
City	:	KENNEDALE
State	:	TX
Zip	:	76060-7804
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5701 WESTCREEK DR
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76133-3301
Country	:	US
Telephone Number	:	682-841-7171
Fax Number	:

Authorized Official
Title or Position	:	DO OWNER
Name	:	BEAUFORD BASPED
Credential	:
Telephone Number	:	682-841-7171

Provider Enumeration Date	:	10/25/2022
Last Update Date	:	10/25/2022

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