Provider Demographics
NPI:1134144223
Name:BEEVE, GREGORY JEROLD (MD)
Entity Type:Individual
Prefix:
First Name:GREGORY
Middle Name:JEROLD
Last Name:BEEVE
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 1:1818 VERDUGO BLVD STE 401
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91208-1421
Mailing Address - Country:US
Mailing Address - Phone:818-790-1145
Mailing Address - Fax:818-790-6387
Practice Address - Street 1:1818 VERDUGO BLVD STE 401
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91208-1421
Practice Address - Country:US
Practice Address - Phone:818-790-1145
Practice Address - Fax:818-790-6387
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-12
Last Update Date:2023-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA61657207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA61657Medicare PIN