| Doctor Name: | DR. GLEN ALAN BEEDE |
| NPI Number: | 1407854920 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | DPM |
| License Number: | 1317 |
| Business Practice Address: | 5521 Bellaire Dr S Benbrook, TX - 761095855 |
| Business Phone Number: | 8177639383 |
| Business Fax Number: | 8177639385 |
| Mailing Address: | 5521 Bellaire Dr S, BENBROOK |
| State: | TX |
| Postal Code: | 761095855 |
| Phone Number: | 8177639383 |
| Fax Number: | 8177639385 |
| NPI Enumeration Date: | 07/08/2005 |
| NPI Last Update Date: | 12/22/2009 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 213ES0103X |
| License Number: | 1317 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | TX |
| Taxonomy Type: | Podiatric Medicine & Surgery Service Providers |
| Taxonomy Classification: | Podiatrist |
| Taxonomy Specialization: | Foot & Ankle Surgery |
| Taxonomy Definition: | |