Provider Demographics
NPI:1881789956
Name:LAND, BEVERLY CAREN (DO)
Entity type:Individual
Prefix:DR
First Name:BEVERLY
Middle Name:CAREN
Last Name:LAND
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3511 NW 91ST AVE
Mailing Address - Street 2:
Mailing Address - City:DORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33172-1216
Mailing Address - Country:US
Mailing Address - Phone:305-437-1148
Mailing Address - Fax:305-437-1064
Practice Address - Street 1:3511 NW 91ST AVE
Practice Address - Street 2:
Practice Address - City:DORAL
Practice Address - State:FL
Practice Address - Zip Code:33172-1216
Practice Address - Country:US
Practice Address - Phone:305-437-1148
Practice Address - Fax:305-437-1064
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ4284207QS0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports Medicine