Provider Demographics
NPI:1245438605
Name:MARY ES BEAVER MD PLLC
Entity type:Organization
Organization Name:MARY ES BEAVER MD PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARY-ES
Authorized Official - Middle Name:A
Authorized Official - Last Name:BEAVER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:865-522-3340
Mailing Address - Street 1:930 E EMERALD AVE
Mailing Address - Street 2:SUITE 720
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37917-4539
Mailing Address - Country:US
Mailing Address - Phone:865-522-3340
Mailing Address - Fax:865-522-3511
Practice Address - Street 1:930 E EMERALD AVE
Practice Address - Street 2:SUITE 720
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37917-4539
Practice Address - Country:US
Practice Address - Phone:865-522-3340
Practice Address - Fax:865-522-3511
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-06
Last Update Date:2009-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN39575207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN833019Medicare UPIN