Beau Taylor Vandiver, MD
Plastic Surgery, Plastic Surgery Within the Head and Neck in Mountain Brk, AL. Individual provider (NPI-1).
NPI number1861981102
StatusActive
Last updated in NPPESJun 13, 2023
Details
- NPI
- 1861981102
- Entity type
- Individual (NPI-1)
- Name
- Beau Taylor Vandiver
- Credential
- MD
- Sex
- Male
- Sole proprietor
- No
- Enumeration date
- May 2, 2018
- Certification date
- Jun 13, 2023
- Last updated
- Jun 13, 2023
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 2082S0099X | Plastic Surgery, Plastic Surgery Within the Head and Neck | 39047 | AL | Yes |
| 390200000X | Student in an Organized Health Care Education/Training Program | – | – |
Practice location
2700 Highway 280 S Ste 300Mountain Brk, AL 35223-2445
Phone 205-930-9595 · Fax 205-802-7719
Mailing address
3894 Grants LnIrondale, AL 35210-5510
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