Individual
DR. RODERICK WILLIAM BEAVER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
174 1ST AVE N, ILWACO, WA 98624-9137
(360) 448-0587
Mailing address
34400 NE LESTER AVE, LA CENTER, WA 98629-3413
(360) 448-0587
(360) 263-4928
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
MD00041270
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1016271
—
WA
05
—
8323198
—
WA
Enumeration date
06/09/2006
Last updated
12/02/2022
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