Healthcare Provider Details

I. General information

NPI: 1720031867
Provider Name (Legal Business Name): BEACON OUTPATIENT PHYSICIANS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/18/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8301 NW 12TH ST
DORAL FL
33126-1838
US

IV. Provider business mailing address

8660 W FLAGLER ST SUITE 200
MIAMI FL
33144-2036
US

V. Phone/Fax

Practice location:
  • Phone: 305-227-3884
  • Fax: 305-554-4833
Mailing address:
  • Phone: 305-227-5176
  • Fax: 305-554-4828

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207PE0004X
TaxonomyEmergency Medical Services (Emergency Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: DAVID R NATEMAN
Title or Position: ADMINISTRATOR
Credential: MD
Phone: 786-596-7992