Clifton H Beasley Jr., MD

Primary specialty

Ophthalmology PhysicianTaxonomy code 207W00000X

License

E3851 Issued in TX

Practice address

900 W Magnolia Ave
Suite 202
Fort Worth, TX 76104-8517

Phone

(817) 334-0882

Fax

(817) 334-0885

NPI assigned

Oct 31, 2005

Last updated

Apr 11, 2014By the provider in NPPES

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 3

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

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

{
    "created_epoch": "1130716800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1397174400000",
    "number": "1780675611",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 650037",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752650037",
            "telephone_number": "214-696-2008"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "900 W MAGNOLIA AVE",
            "address_2": "SUITE 202",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "761048517",
            "telephone_number": "817-334-0882",
            "fax_number": "817-334-0885"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BEASLEY",
        "first_name": "CLIFTON",
        "middle_name": "H",
        "name_suffix": "Jr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-10-31",
        "last_updated": "2014-04-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207W00000X",
            "taxonomy_group": "",
            "desc": "Ophthalmology",
            "state": "TX",
            "license": "E3851",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "P00781819",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "48795103",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "48795102",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Bear Tracks Autism Center
• Kiley Beard
• Michael Corey Bearden, LPC
• Beasley Medical Clinic
• Bruce Damon Beasley, PA-C
• George Beasley, D.O.
• Jamarcus Beasley
• Beaty Business Spendthrift Trust
• Andrew Dodson Beaty, M.D.
• Kathrine Kimberly Beaty, FNP

• Ophthalmology Physician in Fort Worth, TX
• Providers in Fort Worth, TX by specialty
• Ophthalmology Physician in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 11, 2014; 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.