Provider Demographics
NPI:1376525675
Name:DAVE, BEENA A (MD)
Entity Type:Individual
Prefix:DR
First Name:BEENA
Middle Name:A
Last Name:DAVE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:3327 COLORADO BLVD
Mailing Address - Street 2:SUITE #200
Mailing Address - City:DENTON
Mailing Address - State:TX
Mailing Address - Zip Code:76210-6865
Mailing Address - Country:US
Mailing Address - Phone:940-382-4060
Mailing Address - Fax:940-380-9282
Practice Address - Street 1:3327 COLORADO BLVD
Practice Address - Street 2:SUITE #200
Practice Address - City:DENTON
Practice Address - State:TX
Practice Address - Zip Code:76210-6865
Practice Address - Country:US
Practice Address - Phone:940-382-4060
Practice Address - Fax:940-380-9282
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-14
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TXG8688207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00GL26Medicare ID - Type Unspecified
TXE77623Medicare UPIN