Provider Demographics
NPI:1497409775
Name:JASON D. BEAVER, MD LLC
Entity Type:Organization
Organization Name:JASON D. BEAVER, MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER AO
Authorized Official - Prefix:
Authorized Official - First Name:JASON
Authorized Official - Middle Name:D
Authorized Official - Last Name:BEAVER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:334-699-7900
Mailing Address - Street 1:2800 ROSS CLARK CIR STE 2
Mailing Address - Street 2:
Mailing Address - City:DOTHAN
Mailing Address - State:AL
Mailing Address - Zip Code:36301-9917
Mailing Address - Country:US
Mailing Address - Phone:334-305-1848
Mailing Address - Fax:334-305-1949
Practice Address - Street 1:2800 ROSS CLARK CIR STE 2
Practice Address - Street 2:
Practice Address - City:DOTHAN
Practice Address - State:AL
Practice Address - Zip Code:36301-9917
Practice Address - Country:US
Practice Address - Phone:334-305-1848
Practice Address - Fax:334-305-1949
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-07
Last Update Date:2022-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty