Individual
DR. JENNIFER SAM BEATY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Taxonomy
Speciality
Code
Description
License number
State
208C00000X
Colon & Rectal Surgery Physician
Primary
24105
NE
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0490938
—
IA
05
—
47053395014
—
NE
01
—
CH7569
RR MEDICARE
NE
Enumeration date
06/22/2006
Last updated
03/17/2009
Update your record
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