Provider Demographics
NPI:1538164876
Name:BEAN, LONNIE JAMES JR (MD)
Entity type:Individual
Prefix:DR
First Name:LONNIE
Middle Name:JAMES
Last Name:BEAN
Suffix:JR
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 1:205 E LAVIELLE ST
Mailing Address - Street 2:
Mailing Address - City:KIRBYVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75956-2119
Mailing Address - Country:US
Mailing Address - Phone:409-423-2217
Mailing Address - Fax:
Practice Address - Street 1:205 E LAVIELLE ST
Practice Address - Street 2:
Practice Address - City:KIRBYVILLE
Practice Address - State:TX
Practice Address - Zip Code:75956-2119
Practice Address - Country:US
Practice Address - Phone:409-423-2217
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-06-14
Last Update Date:2022-07-08
Deactivation Date:2006-03-17
Deactivation Code:
Reactivation Date:2006-05-02
Provider Licenses
StateLicense IDTaxonomies
TXF3744174400000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX098207601Medicaid
TX00EW14Medicare ID - Type Unspecified
TX098207601Medicaid