Provider Demographics
NPI:1073646014
Name:BYRON KEVIN BEAVER, M.D., P.A.
Entity type:Organization
Organization Name:BYRON KEVIN BEAVER, M.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BYRON
Authorized Official - Middle Name:KEVIN
Authorized Official - Last Name:BEAVER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:409-899-8534
Mailing Address - Street 1:PO BOX 202024
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75320-2024
Mailing Address - Country:US
Mailing Address - Phone:409-899-8534
Mailing Address - Fax:409-899-8304
Practice Address - Street 1:755 NORTH 11TH STREET
Practice Address - Street 2:SUITE D1001
Practice Address - City:BEAUMONT
Practice Address - State:TX
Practice Address - Zip Code:77702
Practice Address - Country:US
Practice Address - Phone:409-899-8534
Practice Address - Fax:409-899-8304
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-13
Last Update Date:2018-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL6781207PE0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207PE0005XAllopathic & Osteopathic PhysiciansEmergency MedicineUndersea and Hyperbaric MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXDG1538OtherRAILROAD MEDICARE GROUP
TX0023QJOtherBCBS GROUP
TX0023QJOtherBCBS GROUP