Provider Demographics
NPI:1417923087
Name:SPIVEY, BEVERLY J (MD)
Entity Type:Individual
Prefix:
First Name:BEVERLY
Middle Name:J
Last Name:SPIVEY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 15133
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27704-0133
Mailing Address - Country:US
Mailing Address - Phone:919-477-5152
Mailing Address - Fax:919-477-5474
Practice Address - Street 1:1314 MEDICAL DR
Practice Address - Street 2:SUITE 102
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28304-4442
Practice Address - Country:US
Practice Address - Phone:910-323-2503
Practice Address - Fax:910-323-4260
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-24
Last Update Date:2013-06-13
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NC25957207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC78945OtherBLUE CROSS
NC8978945Medicaid
NC210625AMedicare PIN
NCD27118Medicare UPIN