Individual
DR. BRYAN D BEAVER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2304 KOSSUTH ST, LAFAYETTE, IN 47904-3240
(765) 446-9600
(765) 446-1100
Mailing address
2304 KOSSUTH ST, LAFAYETTE, IN 47904-3240
(765) 446-9600
(765) 446-1100
Taxonomy
Speciality
Code
Description
License number
State
2080N0001X
Neonatal-Perinatal Medicine Physician
Primary
01082967A
IN
2080N0001X
Neonatal-Perinatal Medicine Physician
M1812
GU
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
208338905
—
MO
05
—
300031240
—
IN
Enumeration date
10/10/2006
Last updated
10/15/2019
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