Basic Information
| Provider Information | |||||||||
| NPI: | 1528037512 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BEAVER | ||||||||
| FirstName: | RICHARD | ||||||||
| MiddleName: | LEIGH | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 10125 KATY FWY STE 100 | ||||||||
| Address2: | |||||||||
| City: | HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 770241287 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7134861700 | ||||||||
| FaxNumber: | 7134676775 | ||||||||
| Practice Location | |||||||||
| Address1: | 10125 KATY FWY STE 100 | ||||||||
| Address2: | |||||||||
| City: | HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 770241287 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7134861700 | ||||||||
| FaxNumber: | 7134676775 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/14/2006 | ||||||||
| LastUpdateDate: | 07/25/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 07/25/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207X00000X | L9094 | TX | N | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | 207XX0004X | L9094 | TX | Y | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Foot and Ankle Surgery |
ID Information
| ID | Type | State | Issuer | Description | 8AD234 | 01 | TX | BCBS | OTHER | 212102201 | 05 | TX | MEDICAID | 5978718 | 01 | TX | AETNA | OTHER | P00824674 | 01 | TX | RAILROAD MEDICARE | OTHER |