Provider Demographics
NPI:1972503373
Name:BEAUMONT ADULT MEDICINE, P.A.
Entity Type:Organization
Organization Name:BEAUMONT ADULT MEDICINE, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:M.D.
Authorized Official - Prefix:DR
Authorized Official - First Name:DWIGHT
Authorized Official - Middle Name:MARK
Authorized Official - Last Name:TOUPS
Authorized Official - Suffix:
Authorized Official - Credentials:MD,FACP
Authorized Official - Phone:409-835-8323
Mailing Address - Street 1:3030 NORTH ST
Mailing Address - Street 2:SUITE 420
Mailing Address - City:BEAUMONT
Mailing Address - State:TX
Mailing Address - Zip Code:77702-1433
Mailing Address - Country:US
Mailing Address - Phone:409-835-2900
Mailing Address - Fax:409-835-1350
Practice Address - Street 1:3030 NORTH ST
Practice Address - Street 2:SUITE 420
Practice Address - City:BEAUMONT
Practice Address - State:TX
Practice Address - Zip Code:77702-1433
Practice Address - Country:US
Practice Address - Phone:409-835-2900
Practice Address - Fax:409-835-1350
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-28
Last Update Date:2010-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE8972207R00000X
TXF9244207R00000X
TXG3721207R00000X
TXF8880207R00000X
TXK6672207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00070RMedicare ID - Type Unspecified