Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208200000X | Surgeon | 18092 | WV |
N | 208600000X | Surgeon | 18092 | WV |
Y | 2086S0120X | Pediatric Surgery | 18092 | WV |
NPI | 1326008012 |
---|---|
Provider Name | Bonnie L Beaver |
First Address | Huntington, WV 25701-3656 |
Second Address | Huntington, WV 25701-3656 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/03/2006 |
Last Update Date | 26/09/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0125333000 | (05) | WV |
0495129 | (05) | OH |
64940505 | (05) | KY |
B66748 | (02) | WV |