NPIMap

Organization Active NPI

Roland S. Beverly III, M.D., P.C.

  • Dermatology Physician
  • Aliso Viejo, CA
National Provider Identifier
1659533677
Registry record updated Jul 23, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dermatology PhysicianTaxonomy code 207N00000X
License
G65658 Issued in CA
Legal business name
ROLAND S. BEVERLY III, M.D., P.C.
Practice address
24541 Pacific Park Dr
Suite 103
Aliso Viejo, CA 92656-3065
Phone
(949) 831-3057
Fax
(949) 831-2515
NPI assigned
Jul 1, 2008
Last updated
Jul 23, 2008By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 23, 2008

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

Authorized official

Name
Dr. Roland Spurgeon Beverly III, M.D.NPI 1083687776
Title
Owner
Phone
(949) 831-3057

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dermatology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207N00000X G65658 CA Primary

Addresses

Primary practice location

24541 Pacific Park Dr
Suite 103
Aliso Viejo, CA 92656-3065

Mailing address

24541 Pacific Park Dr
Suite 103
Aliso Viejo, CA 92656-3065
Phone (949) 831-3057

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1214870400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1216771200000",
    "number": "1659533677",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "24541 PACIFIC PARK DR",
            "address_2": "SUITE 103",
            "city": "ALISO VIEJO",
            "state": "CA",
            "postal_code": "926563065",
            "telephone_number": "949-831-3057",
            "fax_number": "949-831-2515"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "24541 PACIFIC PARK DR",
            "address_2": "SUITE 103",
            "city": "ALISO VIEJO",
            "state": "CA",
            "postal_code": "926563065",
            "telephone_number": "949-831-3057",
            "fax_number": "949-831-2515"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ROLAND S. BEVERLY III, M.D., P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-07-01",
        "last_updated": "2008-07-23",
        "status": "A",
        "authorized_official_last_name": "BEVERLY",
        "authorized_official_first_name": "ROLAND",
        "authorized_official_middle_name": "SPURGEON",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "949-831-3057",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_name_suffix": "III",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dermatology",
            "state": "CA",
            "license": "G65658",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Aliso Viejo, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 23, 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.