Provider Demographics
NPI:1063072718
Name:BEVAN, JEFFREY R (MD)
Entity type:Individual
Prefix:
First Name:JEFFREY
Middle Name:R
Last Name:BEVAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PSC 475 BOX 1
Mailing Address - Street 2:
Mailing Address - City:FPO
Mailing Address - State:AP
Mailing Address - Zip Code:96350-1200
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:NAVY SUPPORT FACILITY DIEGO GARCIA MEDICAL CLINIC
Practice Address - Street 2:BRANCH HEALTH CLINIC PSC 466 BOX 3 BUILDING #151
Practice Address - City:FPO
Practice Address - State:AP
Practice Address - Zip Code:96595
Practice Address - Country:GB
Practice Address - Phone:011-246-3704
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-15
Last Update Date:2025-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0116032850207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine