Healthcare Provider Details

I. General information

NPI: 1457341778
Provider Name (Legal Business Name): JON ROBERT BEACHER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/27/2005
Last Update Date: 10/06/2023
Certification Date: 10/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1121 NW 64TH TER STE A
GAINESVILLE FL
32605-4256
US

IV. Provider business mailing address

2000 HEALTH PARK DR STE 2
BRENTWOOD TN
37027-4525
US

V. Phone/Fax

Practice location:
  • Phone: 352-331-5026
  • Fax: 352-332-0318
Mailing address:
  • Phone: 615-372-5068
  • Fax: 844-687-4017

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number065933
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number065933
License Number StateGA
# 3
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License NumberME118908
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: