Provider Demographics
NPI:1114206455
Name:BEALS, RONALD DAVID (MD)
Entity Type:Individual
Prefix:
First Name:RONALD
Middle Name:DAVID
Last Name:BEALS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9030 OLD HICKORY RD
Mailing Address - Street 2:
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75703-7651
Mailing Address - Country:US
Mailing Address - Phone:903-561-6274
Mailing Address - Fax:903-561-6274
Practice Address - Street 1:9030 OLD HICKORY RD
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75703-7651
Practice Address - Country:US
Practice Address - Phone:903-561-6274
Practice Address - Fax:903-561-6274
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-04
Last Update Date:2011-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH1552207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXC13293Medicare UPIN