Basic Information
| Provider Information | |||||||||
| NPI: | 1831326743 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BEVINAL | ||||||||
| FirstName: | MANZOOR | ||||||||
| MiddleName: | AHAMED | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 60465 | ||||||||
| Address2: | |||||||||
| City: | CORPUS CHRISTI | ||||||||
| State: | TX | ||||||||
| PostalCode: | 784660465 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3618823198 | ||||||||
| FaxNumber: | 3618841912 | ||||||||
| Practice Location | |||||||||
| Address1: | 3315 S ALAMEDA ST | ||||||||
| Address2: | |||||||||
| City: | CORPUS CHRISTI | ||||||||
| State: | TX | ||||||||
| PostalCode: | 784111820 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3618823198 | ||||||||
| FaxNumber: | 3618841912 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/18/2009 | ||||||||
| LastUpdateDate: | 07/16/2013 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | P2595 | TX | N | Allopathic & Osteopathic Physicians | Internal Medicine | 208M00000X | 2012-01338 | NC | Y | Allopathic & Osteopathic Physicians | Hospitalist |
ID Information
| ID | Type | State | Issuer | Description | P2595 | 01 | TX | MEDICAL LICENSE | OTHER | 5920750 | 05 | NC | MEDICAID |