Provider Demographics
NPI:1639145246
Name:BEYER, CAROL B (MD)
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:B
Last Name:BEYER
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 1:1323 E FRANKLIN ST
Mailing Address - Street 2:SUITE 105
Mailing Address - City:HILLSBORO
Mailing Address - State:TX
Mailing Address - Zip Code:76645-2678
Mailing Address - Country:US
Mailing Address - Phone:254-582-7481
Mailing Address - Fax:254-580-1584
Practice Address - Street 1:1323 E FRANKLIN ST
Practice Address - Street 2:SUITE 105
Practice Address - City:HILLSBORO
Practice Address - State:TX
Practice Address - Zip Code:76645-2678
Practice Address - Country:US
Practice Address - Phone:254-582-7481
Practice Address - Fax:254-580-1584
Is Sole Proprietor?:No
Enumeration Date:2006-02-23
Last Update Date:2010-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF1386208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX121461101Medicaid
TX823495Medicare ID - Type Unspecified
TX121461101Medicaid