Provider Demographics
NPI:1184868572
Name:PAUL DWIGHT BEERY, MD
Entity type:Organization
Organization Name:PAUL DWIGHT BEERY, MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:DWIGHT
Authorized Official - Last Name:BEERY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:817-994-2836
Mailing Address - Street 1:PO BOX 490
Mailing Address - Street 2:
Mailing Address - City:WEATHERFORD
Mailing Address - State:TX
Mailing Address - Zip Code:76086-0490
Mailing Address - Country:US
Mailing Address - Phone:817-478-9588
Mailing Address - Fax:817-563-6344
Practice Address - Street 1:713 E ANDERSON ST
Practice Address - Street 2:
Practice Address - City:WEATHERFORD
Practice Address - State:TX
Practice Address - Zip Code:76086-5705
Practice Address - Country:US
Practice Address - Phone:817-596-8751
Practice Address - Fax:817-599-1441
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-29
Last Update Date:2009-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXMDD40292085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty