Provider Demographics
NPI:1851780241
Name:BEAVER MEDICAL INCORPORATED
Entity Type:Organization
Organization Name:BEAVER MEDICAL INCORPORATED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:PROTHRO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:775-857-2876
Mailing Address - Street 1:5000 SMITHRIDGE DR STE D11
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89502-5654
Mailing Address - Country:US
Mailing Address - Phone:775-857-2876
Mailing Address - Fax:775-857-2878
Practice Address - Street 1:5000 SMITHRIDGE DR STE D11
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89502-5654
Practice Address - Country:US
Practice Address - Phone:775-857-2876
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-22
Last Update Date:2015-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV7123207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty