Provider Demographics
NPI:1508837212
Name:BEALL, VIRGINIA B (MD)
Entity Type:Individual
Prefix:
First Name:VIRGINIA
Middle Name:B
Last Name:BEALL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2440 E 5TH ST
Mailing Address - Street 2:
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75701-3592
Mailing Address - Country:US
Mailing Address - Phone:903-595-0500
Mailing Address - Fax:903-595-2153
Practice Address - Street 1:2440 E 5TH ST
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75701-3592
Practice Address - Country:US
Practice Address - Phone:903-595-0500
Practice Address - Fax:903-595-2153
Is Sole Proprietor?:No
Enumeration Date:2006-01-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH6040207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX85Z605Medicare ID - Type Unspecified
TXF32199Medicare UPIN