Individual
JEFFORY W BEATY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
700 E MARSHALL AVE, LONGVIEW, TX 75601-5580
(903) 315-2000
Mailing address
PO BOX 94670, OKLAHOMA CITY, OK 73143-4670
(405) 682-3303
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
K2415
TX
208D00000X
General Practice Physician
K2415
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
104584101
—
TX
01
—
85X883
BLUE CROSS
TX
Enumeration date
10/25/2005
Last updated
07/07/2022
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