Healthcare Provider Details

I. General information

NPI: 1134179336
Provider Name (Legal Business Name): STEPHEN PAUL BEALS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/11/2006
Last Update Date: 09/27/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5410 N SCOTTSDALE RD SUITE E-400
PARADISE VALLEY AZ
85253-5927
US

IV. Provider business mailing address

5410 N SCOTTSDALE RD SUITE E-400
PARADISE VALLEY AZ
85253-5927
US

V. Phone/Fax

Practice location:
  • Phone: 480-947-6788
  • Fax: 602-926-2597
Mailing address:
  • Phone: 480-947-6788
  • Fax: 602-926-2597

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number15290
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: