Individual
DR. JASON D. BEAVER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2800 ROSS CLARK CIR STE 2, DOTHAN, AL 36301-9917
(334) 305-1848
(334) 305-1849
Mailing address
2800 ROSS CLARK CIR STE 2, DOTHAN, AL 36301-9917
(334) 305-1848
(334) 305-1849
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
21102
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
009936495
—
AL
01
—
051518009
AL BCBS # FOR OFFICE #2
AL
01
—
051518010
AL BCBS # FOR OFFICE #1
AL
05
—
131066
—
AL
Enumeration date
06/15/2005
Last updated
03/31/2022
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