Walter R Beaver, M.D.

Primary specialty

Orthopaedic Surgery PhysicianTaxonomy code 207X00000X

License

9453 Issued in TN

Practice address

3 Professional Park Dr
Suite 21
Johnson City, TN 37604-6529

Phone

(423) 434-6300

Fax

(423) 434-6312

NPI assigned

Jan 24, 2006

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1138060800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1209945600000",
    "number": "1417927211",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3 PROFESSIONAL PARK DR",
            "address_2": "SUITE 21",
            "city": "JOHNSON CITY",
            "state": "TN",
            "postal_code": "376046529",
            "telephone_number": "423-434-6300",
            "fax_number": "423-434-6312"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3 PROFESSIONAL PARK DR",
            "address_2": "SUITE 21",
            "city": "JOHNSON CITY",
            "state": "TN",
            "postal_code": "376046529",
            "telephone_number": "423-434-6300",
            "fax_number": "423-434-6312"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BEAVER",
        "first_name": "WALTER",
        "middle_name": "R",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-01-24",
        "last_updated": "2008-05-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207X00000X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery",
            "state": "TN",
            "license": "9453",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3172495",
            "state": "TN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "5903974",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Christy Rayne Beane, PHARM.D.
• Sheila Francine Beasley, CRNA
• Dayla Beaudrot, DPT
• Heather L Beaudry, PHD
• Brooklyn Beaupre, AG-ACNP
• Emily Kendall Beck, PH.D.
• Andrew L Becker, D.O.
• Teresa A. Becker, NP
• Vincent Gerard Becker, M.D.
• Debra Karnes Beebe, PT

• Orthopaedic Surgery Physician in Johnson City, TN
• Providers in Johnson City, TN by specialty
• Orthopaedic Surgery Physician in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 5, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.