Provider Demographics
NPI:1164687828
Name:BEARD, JUSTIN CASEY (PA)
Entity Type:Individual
Prefix:
First Name:JUSTIN
Middle Name:CASEY
Last Name:BEARD
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:8616 GREENVILLE AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75243-7166
Mailing Address - Country:US
Mailing Address - Phone:214-272-9710
Mailing Address - Fax:214-272-9709
Practice Address - Street 1:8616 GREENVILLE AVE STE 100
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75243-7166
Practice Address - Country:US
Practice Address - Phone:214-272-9710
Practice Address - Fax:214-272-9709
Is Sole Proprietor?:No
Enumeration Date:2008-07-22
Last Update Date:2008-10-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXPA05709363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant