Provider Demographics
NPI:1548392293
Name:BEAUVOIR, MARIE N (MD)
Entity Type:Individual
Prefix:DR
First Name:MARIE
Middle Name:N
Last Name:BEAUVOIR
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 1:1241 PROSPER COMMONS BLVD STE 108
Mailing Address - Street 2:
Mailing Address - City:PROSPER
Mailing Address - State:TX
Mailing Address - Zip Code:75078-1419
Mailing Address - Country:US
Mailing Address - Phone:847-477-5791
Mailing Address - Fax:
Practice Address - Street 1:3811 N US HIGHWAY 75
Practice Address - Street 2:
Practice Address - City:SHERMAN
Practice Address - State:TX
Practice Address - Zip Code:75090-2580
Practice Address - Country:US
Practice Address - Phone:903-487-0477
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-09
Last Update Date:2020-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK33359207Q00000X
IL036-112594207Q00000X, 207R00000X
TXS1764207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXS1764OtherPHYSICIAN LICENSE
OK33359OtherPHYSICIAN LICENSE
IL36-112594OtherLIC PHY