MEDICARE: DR. JEFFREY L BEATTIE DMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223S0112X	Oral and Maxillofacial Surgery (Dentist)	DN11558	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	190007446	OTHER	FL	RAILROAD MCARE ORL OFC
2	224946	OTHER	FL	WELLCARE ORLANDO OFC
3	850000180	OTHER	FL	RAILROAD MCARE LW OFC
4	BCBS MEDICAL	OTHER	FL	69148
5	06818	OTHER	FL	WELLCARE WINTER PARK OFC
6	190007440	OTHER	FL	RAILROAD MCARE WP OFC
7	224944	OTHER	FL	WELLCARE LONGWOOD OFC

General Provider Information

NPI Number	:	1811986243
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JEFFREY L BEATTIE DMD

Provider Business Mailing Address
First Line	:	1573 W FAIRBANKS AVE
Second Line	:	SUITE 300
City	:	WINTER PARK
State	:	FL
Zip	:	32789-4679
Country	:	US
Telephone Number	:	407-644-0224
Fax Number	:	407-644-2827

Provider Business Practice Location Address
First Line	:	1573 W FAIRBANKS AVE
Second Line	:	SUITE 300
City	:	WINTER PARK
State	:	FL
Zip	:	32789-4679
Country	:	US
Telephone Number	:	407-644-0224
Fax Number	:	407-644-2827

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/18/2005
Last Update Date	:	01/13/2010

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Directions to “ DR. JEFFREY L BEATTIE DMD” Practice Location

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