Healthcare Provider Details

I. General information

NPI: 1083062475
Provider Name (Legal Business Name): BEAU KALMES DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/26/2016
Last Update Date: 06/30/2020
Certification Date: 06/30/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1630 E HERNDON AVE
FRESNO CA
93720-3391
US

IV. Provider business mailing address

300 W 27TH ST
LUMBERTON NC
28358-3075
US

V. Phone/Fax

Practice location:
  • Phone: 559-290-7051
  • Fax: 559-256-5305
Mailing address:
  • Phone: 910-738-2662
  • Fax: 910-272-7153

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number20A18243
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: