Provider Demographics
NPI:1922020023
Name:GENEZ, BEVERLY M (MD)
Entity Type:Individual
Prefix:
First Name:BEVERLY
Middle Name:M
Last Name:GENEZ
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:PO BOX 100523
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:SC
Mailing Address - Zip Code:29501-0523
Mailing Address - Country:US
Mailing Address - Phone:843-883-5010
Mailing Address - Fax:
Practice Address - Street 1:636 G LONGPOINT RD
Practice Address - Street 2:#125
Practice Address - City:MOUNT PLEASANT
Practice Address - State:SC
Practice Address - Zip Code:29464-7905
Practice Address - Country:US
Practice Address - Phone:843-352-0674
Practice Address - Fax:843-971-3382
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2008-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC142492085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC142492Medicaid
SCE13724Medicare UPIN
SCE13724Medicare ID - Type UnspecifiedMEDICARE OF SC