Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207V00000X | Obstetrician & Gynecologist | 0101233854 | VA |
N | 207VF0040X | Female Pelvic Medicine and Reconstructive Surgeon | 0101233854 | VA |
NPI | 1528028305 |
---|---|
Provider Name | Dr. Beverley B Clary III |
First Address | North Chesterfield, VA 23235-4778 |
Second Address | Richmond, VA 23229-4936 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/03/2006 |
Last Update Date | 31/01/2022 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
010180716 | (05) | VA |
C06527 | MEDICARE GROUP NUMBER (01) |