Individual
BRUCE BEAVERS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
8220 WALNUT HILL LN, SUITE 300, DALLAS, TX 75231-4427
(214) 265-1900
Mailing address
PO BOX 678333, DALLAS, TX 75267-8333
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
G3143
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
889161
BCBS
TX
Enumeration date
12/27/2005
Last updated
05/24/2011
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