Beveridge, Jacques David
Beveridge, Jacques David is an individual health care provider with primary practice located at 3952 Parkview Dr , Cheyenne WY 82001-8102. He recently has only one registered license in Other Service Providers / Specialist, which is considered as his primary health care specialty. Beveridge, Jacques David can be contacted via phone (307) 637-7700.Contact Information
Primary practice address
3952 Parkview Dr
Cheyenne WY 82001-8102
Phone: (307) 637-7700
Fax: (307) 637-5672
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Other Service Providers / Specialist | 174400000X | 6275A | Wyoming |
Profile Details
| NPI number | 1023283843 |
|---|---|
| LBN Legal business name | Beveridge, Jacques David |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Apr 23rd, 2008 |
| Last updated | Dec 19th, 2011 - about 13 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1023283843 | NPPES |
| Wyoming | MEDICAID | 114992000 | |
| Wyoming | Other | W22005 |
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