Provider Demographics
NPI:1578567962
Name:BEAVEN, BARRY JAMES (MD)
Entity Type:Individual
Prefix:DR
First Name:BARRY
Middle Name:JAMES
Last Name:BEAVEN
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Gender:M
Credentials:MD
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Mailing Address - Street 1:7601 JEFFERSON ST NE
Mailing Address - Street 2:STE 340
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87109-4496
Mailing Address - Country:US
Mailing Address - Phone:505-338-3851
Mailing Address - Fax:505-338-3859
Practice Address - Street 1:101 HOSPITAL LOOP NE
Practice Address - Street 2:STE 109
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87109-2129
Practice Address - Country:US
Practice Address - Phone:505-923-4648
Practice Address - Fax:844-625-9095
Is Sole Proprietor?:No
Enumeration Date:2005-06-13
Last Update Date:2015-08-19
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Provider Licenses
StateLicense IDTaxonomies
PAMD023925E207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAB41934Medicare UPIN
PA446906Medicare ID - Type Unspecified