Provider Demographics
NPI:1730433038
Name:BEAUMONT KIDNEY SPECIALISTS, PA
Entity type:Organization
Organization Name:BEAUMONT KIDNEY SPECIALISTS, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RAYMOND
Authorized Official - Middle Name:
Authorized Official - Last Name:DERDERIAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:409-554-0911
Mailing Address - Street 1:2965 HARRISON STREET, SUITE 317
Mailing Address - Street 2:
Mailing Address - City:BEAUMONT
Mailing Address - State:TX
Mailing Address - Zip Code:77702-1150
Mailing Address - Country:US
Mailing Address - Phone:409-554-0911
Mailing Address - Fax:409-554-0912
Practice Address - Street 1:2965 HARRISON STREET, SUITE 317
Practice Address - Street 2:
Practice Address - City:BEAUMONT
Practice Address - State:TX
Practice Address - Zip Code:77702-1150
Practice Address - Country:US
Practice Address - Phone:409-554-0911
Practice Address - Fax:409-554-0912
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-08
Last Update Date:2012-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty