Provider Demographics
NPI:1497200935
Name:ANDREW D BEATY MD PA
Entity Type:Organization
Organization Name:ANDREW D BEATY MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:D
Authorized Official - Last Name:BEATY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:817-315-2550
Mailing Address - Street 1:4200 S HULEN ST STE 230
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76109-4924
Mailing Address - Country:US
Mailing Address - Phone:817-315-2550
Mailing Address - Fax:817-732-4660
Practice Address - Street 1:4200 S HULEN ST STE 230
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76109-4924
Practice Address - Country:US
Practice Address - Phone:817-315-2550
Practice Address - Fax:817-732-4660
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-24
Last Update Date:2020-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX207K00000X, 207KA0200X, 207RA0201X, 2080P0201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207KA0200XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyAllergyGroup - Multi-Specialty
No207K00000XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyGroup - Multi-Specialty
No207RA0201XAllopathic & Osteopathic PhysiciansInternal MedicineAllergy & ImmunologyGroup - Multi-Specialty
No2080P0201XAllopathic & Osteopathic PhysiciansPediatricsPediatric Allergy/ImmunologyGroup - Multi-Specialty