Provider Demographics
NPI:1770909954
Name:BEARD, DARYL MARCELL
Entity type:Individual
Prefix:
First Name:DARYL
Middle Name:MARCELL
Last Name:BEARD
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11528 OLD HAMMOND HWY
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70816-8400
Mailing Address - Country:US
Mailing Address - Phone:123-456-7890
Mailing Address - Fax:
Practice Address - Street 1:11070 MEAD RD APT 0000
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70816-2299
Practice Address - Country:US
Practice Address - Phone:225-445-4931
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-11
Last Update Date:2015-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)