Provider Demographics
NPI:1205329182
Name:GEARREALD, BEVERLY (MD)
Entity type:Individual
Prefix:DR
First Name:BEVERLY
Middle Name:
Last Name:GEARREALD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MS
Other - First Name:BEVERLY
Other - Middle Name:
Other - Last Name:COPE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:606 OAKLAND AVE APT 211
Mailing Address - Street 2:
Mailing Address - City:URBANA
Mailing Address - State:IL
Mailing Address - Zip Code:61802-2062
Mailing Address - Country:US
Mailing Address - Phone:872-444-6384
Mailing Address - Fax:
Practice Address - Street 1:611 W PARK ST
Practice Address - Street 2:
Practice Address - City:URBANA
Practice Address - State:IL
Practice Address - Zip Code:61801-2529
Practice Address - Country:US
Practice Address - Phone:217-383-3311
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-14
Last Update Date:2018-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL125.073082208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery