Provider Demographics
NPI:1225133002
Name:BEAUMONT DERMATOLOGY & FAMILY PRACTICE, LLP
Entity Type:Organization
Organization Name:BEAUMONT DERMATOLOGY & FAMILY PRACTICE, LLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SIDNEY
Authorized Official - Middle Name:A
Authorized Official - Last Name:MARCHAND
Authorized Official - Suffix:IV
Authorized Official - Credentials:MD
Authorized Official - Phone:409-899-2500
Mailing Address - Street 1:3030 NORTH ST
Mailing Address - Street 2:SUITE 430
Mailing Address - City:BEAUMONT
Mailing Address - State:TX
Mailing Address - Zip Code:77702-1433
Mailing Address - Country:US
Mailing Address - Phone:409-899-2500
Mailing Address - Fax:409-898-7579
Practice Address - Street 1:3030 NORTH ST
Practice Address - Street 2:SUITE 430
Practice Address - City:BEAUMONT
Practice Address - State:TX
Practice Address - Zip Code:77702-1433
Practice Address - Country:US
Practice Address - Phone:409-899-2500
Practice Address - Fax:409-898-7579
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-14
Last Update Date:2018-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207N00000X, 207Q00000X
TXL8124208D00000X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
No207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Multi-Specialty
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00812WMedicare PIN