Provider Demographics
NPI:1861543787
Name:BEARD, MARIANNE (DO)
Entity type:Individual
Prefix:DR
First Name:MARIANNE
Middle Name:
Last Name:BEARD
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 121225
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76012-1225
Mailing Address - Country:US
Mailing Address - Phone:817-795-5525
Mailing Address - Fax:
Practice Address - Street 1:1216 FLORIDA DR
Practice Address - Street 2:120
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76015-2387
Practice Address - Country:US
Practice Address - Phone:817-795-5525
Practice Address - Fax:800-811-6593
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-16
Last Update Date:2013-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH0168207QG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX099708401Medicaid
TX00QC82Medicare PIN
TXA65355Medicare UPIN