| Beaver Medical Group, Pllc | |
|
7541 Us Highway 87 E. Suite #1 San Antonio TX 78263-2407 | |
| (210) 648-9900 | |
| (210) 648-9902 |
| Full Name | Beaver Medical Group, Pllc |
|---|---|
| Speciality | Internal Medicine |
| Location | 7541 Us Highway 87 E., San Antonio, Texas |
| Authorized Official Name and Position | Tracey L Frias (PRACTICE MANAGER) |
| Authorized Official Contact | 2106489900 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Beaver Medical Group, Pllc 7541 Us Highway 87 E. Suite #1 San Antonio TX 78263 Ph: (210) 648-9900 | Beaver Medical Group, Pllc 7541 Us Highway 87 E. Suite #1 San Antonio TX 78263-2407 Ph: (210) 648-9900 |
| NPI Number | 1093038648 |
|---|---|
| Provider Enumeration Date | 03/10/2010 |
| Last Update Date | 04/09/2019 |
| Medicare PECOS PAC ID | 6507995826 |
|---|---|
| Medicare Enrollment ID | O20100525000931 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1093038648 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | (* (Not Available)) | Primary |
| 363L00000X | Nurse Practitioner | (* (Not Available)) | Secondary |
| Provider Name | Gail L Beaver |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1689665887 PECOS PAC ID: 3779509849 Enrollment ID: I20051018000740 |
| Provider Name | Vincent G Gonzaba |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1538192489 PECOS PAC ID: 1254473093 Enrollment ID: I20100116000425 |
| Provider Name | Nichole Graeber |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1871910521 PECOS PAC ID: 4082986724 Enrollment ID: I20170816000559 |
| Provider Name | Jessa P Perry |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1023528361 PECOS PAC ID: 8729346309 Enrollment ID: I20180103003155 |
| Provider Name | Hailey S Leach |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1619641677 PECOS PAC ID: 7618372632 Enrollment ID: I20210828000243 |
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