Provider Demographics
NPI:1275518250
Name:BEAVERSON, ANTHONY BRET (MD)
Entity Type:Individual
Prefix:DR
First Name:ANTHONY
Middle Name:BRET
Last Name:BEAVERSON
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 1:4708 CANVASBACK BLVD
Mailing Address - Street 2:
Mailing Address - City:MCKINNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75070-9034
Mailing Address - Country:US
Mailing Address - Phone:972-562-8053
Mailing Address - Fax:
Practice Address - Street 1:500 N HIGHLAND AVE
Practice Address - Street 2:
Practice Address - City:SHERMAN
Practice Address - State:TX
Practice Address - Zip Code:75092-7354
Practice Address - Country:US
Practice Address - Phone:972-870-4205
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-13
Last Update Date:2010-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ9966207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX134272711Medicaid
TX134272710Medicaid
TX930102137OtherMEDICARE RAILROAD
TX8A0477OtherBCBS
TXP00198884OtherRAIL ROAD MEDICARE
TX8M6697OtherBLUE CROSS BLUE SHIELD
TX134272714Medicaid
TX8S9031OtherBLUE CROSS BLUE SHIELD
TX134272708Medicaid
TX134272714Medicaid
TX87234NMedicare PIN
TX134272708Medicaid
TX8M6697OtherBLUE CROSS BLUE SHIELD
TX8S9031OtherBLUE CROSS BLUE SHIELD
TXP00303538Medicare PIN