Provider Demographics
NPI:1982688800
Name:BEAVER, BYRON KEVIN (MD)
Entity Type:Individual
Prefix:DR
First Name:BYRON
Middle Name:KEVIN
Last Name:BEAVER
Suffix:
Gender:M
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 16474
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72231-6474
Mailing Address - Country:US
Mailing Address - Phone:501-202-3638
Mailing Address - Fax:501-202-3639
Practice Address - Street 1:3333 SPRINGHILL DR
Practice Address - Street 2:SUITE 2002
Practice Address - City:NORTH LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72117-2922
Practice Address - Country:US
Practice Address - Phone:501-202-3638
Practice Address - Fax:501-202-3639
Is Sole Proprietor?:No
Enumeration Date:2005-12-05
Last Update Date:2011-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL6781207PE0005X
ARE-6065207PE0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207PE0005XAllopathic & Osteopathic PhysiciansEmergency MedicineUndersea and Hyperbaric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX160896002Medicaid
TX8AJ534OtherBCBS INDIVIDUAL
AR179030001Medicaid
TXP00094736OtherRAILROAD MEDICARE
TXH48129Medicare UPIN
AR179030001Medicaid
AR5H962G323Medicare PIN