Basic Information
| Provider Information | |||||||||
| NPI: | 1962566117 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BEERY | ||||||||
| FirstName: | PAUL | ||||||||
| MiddleName: | DWIGHT | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 490 | ||||||||
| Address2: | |||||||||
| City: | WEATHERFORD | ||||||||
| State: | TX | ||||||||
| PostalCode: | 760860490 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8177382000 | ||||||||
| FaxNumber: | 8177382224 | ||||||||
| Practice Location | |||||||||
| Address1: | 713 E ANDERSON ST | ||||||||
| Address2: | |||||||||
| City: | WEATHERFORD | ||||||||
| State: | TX | ||||||||
| PostalCode: | 760865705 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8175968751 | ||||||||
| FaxNumber: | 8175991441 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/21/2006 | ||||||||
| LastUpdateDate: | 02/19/2014 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0202X | MDD4029 | TX | Y | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
ID Information
| ID | Type | State | Issuer | Description | 033047401 | 05 | TX | MEDICAID | 15654 | 01 | TX | AMERIGROUP | OTHER | 826302203A | 01 | TX | PALMETTO | OTHER | 00ET77 | 01 | TX | BCBS | OTHER | MDD4029 | 01 | TX | LIC NUMBER | OTHER |