Healthcare Provider Details

I. General information

NPI: 1306853700
Provider Name (Legal Business Name): THOMAS E BEATROUS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/01/2006
Last Update Date: 05/09/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 SAINT LUKES DR
MONTGOMERY AL
36117-7102
US

IV. Provider business mailing address

1400 AFFLINK PL STE 100
TUSCALOOSA AL
35406-2289
US

V. Phone/Fax

Practice location:
  • Phone: 334-273-8877
  • Fax: 334-273-9733
Mailing address:
  • Phone: 205-366-9740
  • Fax: 205-344-9992

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number19860
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: