Individual
FREDRICK DAVID BEAVER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
2750 N. NINO PLACE, COCHISE, AZ 85606
(520) 253-0352
Mailing address
PO BOX 272, DRAGOON, AZ 85609-0272
(520) 253-0352
Taxonomy
Speciality
Code
Description
License number
State
385HR2055X
Child Mental Illness Respite Care
Primary
—
AZ
Other
Enumeration date
12/26/2007
Last updated
01/14/2008
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