Provider Demographics
NPI:1801513437
Name:BEAUFORD BASPED JR DO PLLC
Entity type:Organization
Organization Name:BEAUFORD BASPED JR DO PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DO OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BEAUFORD
Authorized Official - Middle Name:
Authorized Official - Last Name:BASPED
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:682-841-7171
Mailing Address - Street 1:7510 HUDSON CEMETERY RD
Mailing Address - Street 2:
Mailing Address - City:KENNEDALE
Mailing Address - State:TX
Mailing Address - Zip Code:76060-7804
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5701 WESTCREEK DR
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76133-3301
Practice Address - Country:US
Practice Address - Phone:682-841-7171
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-25
Last Update Date:2022-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty