Provider Demographics
NPI:1811958119
Name:DAVID M. BEYER, D.O., P.A.
Entity type:Organization
Organization Name:DAVID M. BEYER, D.O., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:M
Authorized Official - Last Name:BEYER
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:817-731-0801
Mailing Address - Street 1:4201 CAMP BOWIE BLVD
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76107-3928
Mailing Address - Country:US
Mailing Address - Phone:817-731-0801
Mailing Address - Fax:817-731-8468
Practice Address - Street 1:4201 CAMP BOWIE BLVD
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76107-3928
Practice Address - Country:US
Practice Address - Phone:817-731-0801
Practice Address - Fax:817-731-8468
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXD5350207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXD5350OtherSTATE MEDICAL LICENSE
TXD97214Medicare UPIN
TX89M601Medicare ID - Type UnspecifiedPROVIDER