Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207X00000X | Orthopaedic Surgeon | F3403 | TX |
NPI | 1023090024 |
---|---|
Provider Name | Terry Jackman Beal |
First Address | Killeen, TX 76540-0938 |
Second Address | Killeen, TX 76549-4110 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/11/2005 |
Last Update Date | 30/07/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
108270100 | FIRST CARE (01) | TX |
120150103 | (05) | TX |
4409159 | AETNA (01) | TX |
742175905001 | TRICARE (01) | TX |
806541 | GREAT WEST (01) | TX |
826203342 | MEDICARE RAILROAD (01) | TX |
83042 | SCOTT & WHITE (01) | TX |
85280F | BLUE CROSS BLUE SHIELD (01) | TX |
C13291 | (02) |