Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208200000X | Surgeon | MD.200997 | LA |
N | 208600000X | Surgeon | MD.200997 | LA |
Y | 2086S0129X | Vascular Surgeon | N6165 | TX |
NPI | 1164606026 |
---|---|
Provider Name | Dr. Thomas James Beadle JR. |
First Address | Live Oak, TX 78233-4117 |
Second Address | Live Oak, TX 78233-4117 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/12/2007 |
Last Update Date | 05/06/2020 |