Healthcare Provider Details

I. General information

NPI: 1023076825
Provider Name (Legal Business Name): DOUGLAS BRUCE BEECH M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/02/2006
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

US ARMY HEALTH CLINIC VICENZA
APO AE
09630
US

IV. Provider business mailing address

CMR 427 BOX 921
APO AE
09630
US

V. Phone/Fax

Practice location:
  • Phone: 390444717821
  • Fax:
Mailing address:
  • Phone: 390444985097
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberD0056205
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: