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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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