Provider Demographics
NPI:1447260781
Name:BEATY, WILLIAM R (MD)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:R
Last Name:BEATY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7030 NEW SANGER RD STE 204
Mailing Address - Street 2:
Mailing Address - City:WACO
Mailing Address - State:TX
Mailing Address - Zip Code:76712-3991
Mailing Address - Country:US
Mailing Address - Phone:254-757-2999
Mailing Address - Fax:254-755-8515
Practice Address - Street 1:7030 NEW SANGER RD STE 204
Practice Address - Street 2:
Practice Address - City:WACO
Practice Address - State:TX
Practice Address - Zip Code:76712-3991
Practice Address - Country:US
Practice Address - Phone:254-757-2999
Practice Address - Fax:254-755-8515
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-09
Last Update Date:2007-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE0802207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00CE13OtherBLUECROSS & BLUESHIELD
TXD47911Medicare UPIN
00CE13Medicare ID - Type Unspecified