Provider Demographics
NPI:1962566117
Name:BEERY, PAUL DWIGHT (MD)
Entity type:Individual
Prefix:DR
First Name:PAUL
Middle Name:DWIGHT
Last Name:BEERY
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:PO BOX 490
Mailing Address - Street 2:
Mailing Address - City:WEATHERFORD
Mailing Address - State:TX
Mailing Address - Zip Code:76086-0490
Mailing Address - Country:US
Mailing Address - Phone:817-738-2000
Mailing Address - Fax:817-738-2224
Practice Address - Street 1:713 E ANDERSON ST
Practice Address - Street 2:
Practice Address - City:WEATHERFORD
Practice Address - State:TX
Practice Address - Zip Code:76086-5705
Practice Address - Country:US
Practice Address - Phone:817-596-8751
Practice Address - Fax:817-599-1441
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-21
Last Update Date:2014-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXMDD40292085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX033047401Medicaid
TX15654OtherAMERIGROUP
TX826302203AOtherPALMETTO
TX00ET77OtherBCBS
TXMDD4029OtherLIC NUMBER
TX826302203AOtherPALMETTO
TX00ET77OtherBCBS
TX321254YK6LMedicare PIN
TX321254YK6NMedicare PIN
TX00JO62Medicare PIN
TXE21625Medicare UPIN
TX033047401Medicaid
TX321254YK6GMedicare PIN