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Organization
ST. JOHN'S EMERGENCY PHYSICIANS, INC., P.S.
Active
Organization
ST. JOHN'S EMERGENCY PHYSICIANS, INC., P.S.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. RODERICK W. BEAVER MD (PRESIDENT)
(360) 448-0587
Entity
Organization
Contact information
Practice address
1615 DELAWARE ST, LONGVIEW, WA 98632-2367
(360) 414-2000
Mailing address
PO BOX 101519, PASADENA, CA 91189-0009
(626) 447-0296
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1028089
—
WA
05
—
227368
—
OR
Enumeration date
07/08/2006
Last updated
04/05/2020
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