Individual
MR. CARL JOSEPH BEAUDRY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2501 JIMMY JOHNSON BLVD, SUITE 202, PORT ARTHUR, TX 77640-2007
(409) 722-4446
(409) 722-4448
Mailing address
2501 JIMMY JOHNSON BLVD, SUITE 202, PORT ARTHUR, TX 77640-2007
(409) 722-4446
(409) 722-4448
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
E9531
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0082GS
BLUE CROSS
TX
05
—
097777901
—
TX
01
—
687562
AETNA
TX
01
—
CIGNA
3739015001
TX
01
—
E9531
PHYSICIAN PERMIT
TX
01
—
S0033018
DPS
TX
Enumeration date
05/28/2006
Last updated
03/07/2023
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