Basic Information
| Provider Information | |||||||||
| NPI: | 1881833218 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | BEEVILLE INTERNISTS, PLLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 3808 | ||||||||
| Address2: | |||||||||
| City: | CORPUS CHRISTI | ||||||||
| State: | TX | ||||||||
| PostalCode: | 784633808 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3618842904 | ||||||||
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| Practice Location | |||||||||
| Address1: | 711 E HOUSTON ST | ||||||||
| Address2: | |||||||||
| City: | BEEVILLE | ||||||||
| State: | TX | ||||||||
| PostalCode: | 781025023 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3613432258 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/09/2009 | ||||||||
| LastUpdateDate: | 01/06/2011 | ||||||||
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| AuthorizedOfficialLastName: | KHAN | ||||||||
| AuthorizedOfficialFirstName: | BEHRAM | ||||||||
| AuthorizedOfficialMiddleName: | A | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 3613432258 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RN0300X | M2669 | TX | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Nephrology |
ID Information
| ID | Type | State | Issuer | Description | 179720107 | 05 | TX | MEDICAID | M2669 | 01 | TX | PHYSICIAN PERMIT | OTHER | 204852202 | 05 | TX | MEDICAID |