Individual
CLARENCE HENRY BEAVERS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
207 E MEADOW RD STE 1, EDEN, NC 27288-3469
(336) 627-3194
(336) 627-3208
Mailing address
PO BOX 1693, BRYSON CITY, NC 28713-1693
(336) 967-0004
(828) 538-4441
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
39543
NC
207Q00000X
Family Medicine Physician
39543
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1871595082
—
NC
01
—
2154554D
MEDICARE PTAN
NC
01
—
P00935587
RAILROAD MEDICARE
NC
Enumeration date
06/01/2005
Last updated
08/10/2023
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