Provider Demographics
NPI:1467654541
Name:BEATHARD, GERALD A (MD)
Entity Type:Individual
Prefix:
First Name:GERALD
Middle Name:A
Last Name:BEATHARD
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 1:5135 HOLLY TERRACE DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77056-2125
Mailing Address - Country:US
Mailing Address - Phone:512-970-9054
Mailing Address - Fax:281-501-0014
Practice Address - Street 1:5135 HOLLY TERRACE DR
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77056-2125
Practice Address - Country:US
Practice Address - Phone:512-970-9054
Practice Address - Fax:281-501-0014
Is Sole Proprietor?:No
Enumeration Date:2007-06-01
Last Update Date:2012-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXD1543174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist