Provider Demographics
NPI:1376526491
Name:BEVERLY, DAVID TEMPLE IV (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:TEMPLE
Last Name:BEVERLY
Suffix:IV
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 1:34520 BOB WILSON DR
Mailing Address - Street 2:SUITE 202
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92134-2098
Mailing Address - Country:US
Mailing Address - Phone:619-532-6702
Mailing Address - Fax:
Practice Address - Street 1:34520 BOB WILSON DR
Practice Address - Street 2:SUITE 202
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92134-2098
Practice Address - Country:US
Practice Address - Phone:619-532-6702
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-11-22
Last Update Date:2021-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA69902207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAEJ234AMedicare PIN