Individual
CLINT BEAVER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
106 CORPORATE PARK DR, SUITE 200 & 300, MOORESVILLE, NC 28117-7134
(704) 235-9090
(704) 235-9101
Mailing address
PO BOX 60447, CHARLOTTE, NC 28260-0447
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
200901244
NC
207QS0010X
Sports Medicine (Family Medicine) Physician
200901244
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
5915044
—
NC
Enumeration date
06/12/2007
Last updated
10/28/2020
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