Provider Demographics
NPI:1477665552
Name:NESTER, BEVERLY J (MD)
Entity Type:Individual
Prefix:
First Name:BEVERLY
Middle Name:J
Last Name:NESTER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12370 HESPERIA RD
Mailing Address - Street 2:SUITE # 6
Mailing Address - City:VICTORVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:92395-7719
Mailing Address - Country:US
Mailing Address - Phone:760-245-4747
Mailing Address - Fax:
Practice Address - Street 1:15982 QUANTICO RD
Practice Address - Street 2:SUITE E
Practice Address - City:APPLE VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92307-1382
Practice Address - Country:US
Practice Address - Phone:760-810-7800
Practice Address - Fax:760-810-7805
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2012-02-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA46679207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A466790Medicaid
CA080054200OtherRAILROAD MEDICARE
CA080054200OtherRAILROAD MEDICARE
CA00A466790Medicaid