Healthcare Provider Details

I. General information

NPI: 1316282288
Provider Name (Legal Business Name): ROBERT FREDRICK BEAUCHAMP MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/04/2012
Last Update Date: 12/04/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 E WASHINGTON ST SUITE 17
PHOENIX AZ
85004-2492
US

IV. Provider business mailing address

1 E WASHINGTON ST SUITE 17
PHOENIX AZ
85004-2492
US

V. Phone/Fax

Practice location:
  • Phone: 602-255-8512
  • Fax: 602-255-8716
Mailing address:
  • Phone: 602-255-8512
  • Fax: 602-255-8716

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number8520
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: