Healthcare Provider Details

I. General information

NPI: 1245804988
Provider Name (Legal Business Name): HARLEY RICHARD BEESE PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/17/2021
Last Update Date: 03/24/2026
Certification Date: 03/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2946 E BANNER GATEWAY DR
GILBERT AZ
85234
US

IV. Provider business mailing address

2946 E BANNER GATEWAY DR
GILBERT AZ
85234
US

V. Phone/Fax

Practice location:
  • Phone: 480-256-6444
  • Fax: 480-256-3682
Mailing address:
  • Phone: 480-256-6444
  • Fax: 480-256-3682

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number3939
License Number StateSC
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number11454
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: