Provider Demographics
NPI:1992997910
Name:CARL J BEAUDRY, MD, PA
Entity type:Organization
Organization Name:CARL J BEAUDRY, MD, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHANNA
Authorized Official - Middle Name:LAREE
Authorized Official - Last Name:TREJO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:409-722-4446
Mailing Address - Street 1:2501 JIMMY JOHNSON BLVD STE 202
Mailing Address - Street 2:
Mailing Address - City:PORT ARTHUR
Mailing Address - State:TX
Mailing Address - Zip Code:77640-2009
Mailing Address - Country:US
Mailing Address - Phone:409-722-4446
Mailing Address - Fax:409-722-4448
Practice Address - Street 1:2501 JIMMY JOHNSON BLVD STE 202
Practice Address - Street 2:
Practice Address - City:PORT ARTHUR
Practice Address - State:TX
Practice Address - Zip Code:77640-2009
Practice Address - Country:US
Practice Address - Phone:409-722-4446
Practice Address - Fax:409-722-4448
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-14
Last Update Date:2007-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE9531207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8B7430OtherBCBS GROUP