Individual
BEAU TAYLOR VANDIVER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2700 HIGHWAY 280 S STE 300, MOUNTAIN BRK, AL 35223-2445
(205) 930-9595
(205) 802-7719
Mailing address
3894 GRANTS LN, IRONDALE, AL 35210-5510
Taxonomy
Speciality
Code
Description
License number
State
2082S0099X
Plastic Surgery Within the Head and Neck (Plastic Surgery) Physician
Primary
39047
AL
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
05/02/2018
Last updated
06/13/2023
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