Individual
CODY RYAN BEAVER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1500 COOPER ST, FORT WORTH, TX 76104-2710
(682) 885-4405
Mailing address
PO BOX 733784, DALLAS, TX 75373-3784
(682) 885-6483
(682) 885-3113
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
BP2-0041888
TX
207X00000X
Orthopaedic Surgery Physician
R3034
TX
207XP3100X
Pediatric Orthopaedic Surgery Physician
Primary
R3034
TX
208600000X
Surgery Physician
BP1 0036956
TX
Other
Enumeration date
05/17/2010
Last updated
08/01/2023
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