Healthcare Provider Details

I. General information

NPI: 1205803327
Provider Name (Legal Business Name): D'LIVRO LEMAT BEAUCHAMP M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/07/2006
Last Update Date: 06/11/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4705 WOODMERE BLVD
MONTGOMERY AL
36106-3078
US

IV. Provider business mailing address

4705 WOODMERE BLVD
MONTGOMERY AL
36106-3078
US

V. Phone/Fax

Practice location:
  • Phone: 334-558-0262
  • Fax: 334-558-0267
Mailing address:
  • Phone: 334-558-0262
  • Fax: 334-558-0267

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number20243
License Number StateAL
# 2
Primary TaxonomyN
Taxonomy Code207PE0004X
TaxonomyEmergency Medical Services (Emergency Medicine) Physician
License Number20243
License Number StateAL
# 3
Primary TaxonomyN
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License Number20243
License Number StateAL
# 4
Primary TaxonomyN
Taxonomy Code207QA0000X
TaxonomyAdolescent Medicine (Family Medicine) Physician
License Number20243
License Number StateAL
# 5
Primary TaxonomyN
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number20243
License Number StateAL
# 6
Primary TaxonomyN
Taxonomy Code207QB0002X
TaxonomyObesity Medicine (Family Medicine) Physician
License Number20243
License Number StateAL
# 7
Primary TaxonomyN
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License Number20243
License Number StateAL
# 8
Primary TaxonomyN
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License Number20243
License Number StateAL
# 9
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number20243
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: