# JACQUES D. BEVERIDGE MD, INC.

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1114057080
- **Authorized official:** MR. FREDERICK J ZEBROSKI (MANAGER)
- **Authorized official phone:** (307) 332-2223

## Contact information

- **Practice address:** 1460 MAIN ST, SUITE B, LANDER, WY 82520-2657
- **Practice address phone:** (307) 332-2223
- **Mailing address:** 1460 MAIN ST, SUITE B, LANDER, WY 82520-2657
- **Mailing address phone:** (307) 332-2223

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207V00000X | Obstetrics & Gynecology Physician | 6275A | WY | Yes |
| 367A00000X | Advanced Practice Midwife | 8746.0044 | WY | — |

## Other

- **Enumeration date:** 03/07/2007
- **Last updated:** 10/24/2007