Organization
BEAVERS DERMATOLOGY & SKIN SURGERY, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. CLARENCE BEAVERS MD (OWNER)
(336) 627-3194
Entity
Organization
Contact information
Practice address
207 E MEADOW RD STE 1, EDEN, NC 27288-3469
(336) 627-3194
(336) 627-3208
Mailing address
PO BOX 1693, BRYSON CITY, NC 28713-1693
(336) 967-0004
(828) 538-4441
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
39543
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2154554C
MEDICARE
NC
05
—
5917187
—
NC
01
—
DR4608
RAILROAD MEDICARE
NC
Enumeration date
03/30/2011
Last updated
08/10/2023
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