Provider Demographics
NPI:1659579860
Name:BEAVER, GAYLA A (R MR)
Entity Type:Individual
Prefix:
First Name:GAYLA
Middle Name:A
Last Name:BEAVER
Suffix:
Gender:F
Credentials:R MR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:149 LILY DR
Mailing Address - Street 2:
Mailing Address - City:MAUMELLE
Mailing Address - State:AR
Mailing Address - Zip Code:72113-5831
Mailing Address - Country:US
Mailing Address - Phone:501-851-8426
Mailing Address - Fax:
Practice Address - Street 1:11300 FINANCIAL CENTRE PKWY
Practice Address - Street 2:SUITE 400
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72211-3746
Practice Address - Country:US
Practice Address - Phone:501-221-2502
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-10
Last Update Date:2007-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARRT66247100000X
1638982471M1202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2471M1202XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistMagnetic Resonance Imaging
No247100000XTechnologists, Technicians & Other Technical Service ProvidersRadiologic Technologist