Individual
BONNIE L BEAVER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1600 MEDICAL CENTER DR, SUITE 2500, HUNTINGTON, WV 25701-3656
(304) 691-1200
(304) 691-1287
Mailing address
1600 MEDICAL CENTER DR, SUITE 2500, HUNTINGTON, WV 25701-3656
(304) 691-1200
(304) 691-1287
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
18092
WV
2086S0120X
Pediatric Surgery Physician
Primary
18092
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0125333000
—
WV
05
—
0495129
—
OH
05
—
64940505
—
KY
Enumeration date
03/25/2006
Last updated
09/26/2012
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