Healthcare Provider Details

I. General information

NPI: 1821415621
Provider Name (Legal Business Name): JEFFREY L BEAIRD PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/19/2014
Last Update Date: 01/14/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2149 E WARNER RD STE 101
TEMPE AZ
85284-3495
US

IV. Provider business mailing address

2149 E WARNER RD STE 102
TEMPE AZ
85284-3495
US

V. Phone/Fax

Practice location:
  • Phone: 480-610-6100
  • Fax: 480-464-0189
Mailing address:
  • Phone: 480-610-6100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number5668
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: