Provider Demographics
NPI:1053329755
Name:BEAVERS, GENE A (PA-C)
Entity Type:Individual
Prefix:
First Name:GENE
Middle Name:A
Last Name:BEAVERS
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
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Mailing Address - Street 1:8911 N CAPITAL OF TEXAS HWY STE 1110
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78759-7203
Mailing Address - Country:US
Mailing Address - Phone:877-279-5960
Mailing Address - Fax:877-384-3106
Practice Address - Street 1:315 9TH ST SW
Practice Address - Street 2:
Practice Address - City:WILLMAR
Practice Address - State:MN
Practice Address - Zip Code:56201-3132
Practice Address - Country:US
Practice Address - Phone:320-293-4363
Practice Address - Fax:877-384-3106
Is Sole Proprietor?:No
Enumeration Date:2006-08-04
Last Update Date:2023-10-19
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MNMN9369363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant