Provider Demographics
NPI:1023090024
Name:BEAL, TERRY JACKMAN (MD)
Entity type:Individual
Prefix:
First Name:TERRY
Middle Name:JACKMAN
Last Name:BEAL
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 938
Mailing Address - Street 2:
Mailing Address - City:KILLEEN
Mailing Address - State:TX
Mailing Address - Zip Code:76540-0938
Mailing Address - Country:US
Mailing Address - Phone:254-634-6999
Mailing Address - Fax:254-200-4099
Practice Address - Street 1:2117 S CLEAR CREEK RD
Practice Address - Street 2:
Practice Address - City:KILLEEN
Practice Address - State:TX
Practice Address - Zip Code:76549-4110
Practice Address - Country:US
Practice Address - Phone:254-526-0188
Practice Address - Fax:254-200-4090
Is Sole Proprietor?:No
Enumeration Date:2005-11-16
Last Update Date:2008-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF3403207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX742175905001OtherTRICARE
TX85280FOtherBLUE CROSS BLUE SHIELD
TX108270100OtherFIRST CARE
TX806541OtherGREAT WEST
TX826203342OtherMEDICARE RAILROAD
TX4409159OtherAETNA
TX120150103Medicaid
TX83042OtherSCOTT & WHITE
TX0634700001Medicare NSC
TX85280FMedicare PIN
TX826203342OtherMEDICARE RAILROAD