Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | BP2-0041888 | TX |
N | 207X00000X | Orthopaedic Surgeon | R3034 | TX |
Y | 207XP3100X | Pediatric Orthopaedic Surgeon | R3034 | TX |
N | 208200000X | Surgeon | BP1 0036956 | TX |
N | 208600000X | Surgeon | BP1 0036956 | TX |
NPI | 1578881470 |
---|---|
Provider Name | Cody Ryan Beaver |
First Address | Lubbock, TX 79430-9436 |
Second Address | Lubbock, TX 79430 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/05/2010 |
Last Update Date | 23/11/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
200771630A | (05) | OK |
374222303 | (05) | TX |
374222304 | (05) | TX |
85270521 | (05) | NM |