Provider Demographics
NPI:1891976171
Name:BEAUMONT PLASTIC SURGERY ASSOCIATES, P.A.
Entity Type:Organization
Organization Name:BEAUMONT PLASTIC SURGERY ASSOCIATES, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BENJAMIN
Authorized Official - Middle Name:WALLACE
Authorized Official - Last Name:BECKERT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:409-892-6015
Mailing Address - Street 1:755 N 11TH ST
Mailing Address - Street 2:SUITE P3500
Mailing Address - City:BEAUMONT
Mailing Address - State:TX
Mailing Address - Zip Code:77702-1500
Mailing Address - Country:US
Mailing Address - Phone:409-892-6015
Mailing Address - Fax:409-899-1338
Practice Address - Street 1:755 N 11TH ST
Practice Address - Street 2:SUITE P3500
Practice Address - City:BEAUMONT
Practice Address - State:TX
Practice Address - Zip Code:77702-1500
Practice Address - Country:US
Practice Address - Phone:409-892-6015
Practice Address - Fax:409-899-1338
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-15
Last Update Date:2007-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL9621208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0068LWOtherBCBS
TX00488XMedicare PIN