Healthcare Provider Details

I. General information

NPI: 1720960776
Provider Name (Legal Business Name): JEDEDIAH R BEAMAN A.G.B., A.M.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/22/2025
Last Update Date: 04/26/2026
Certification Date: 04/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15580 ROYAL COACH CIR
NORTH FORT MYERS FL
33917-3080
US

IV. Provider business mailing address

15580 ROYAL COACH CIR
NORTH FORT MYERS FL
33917-3080
US

V. Phone/Fax

Practice location:
  • Phone: 989-944-8023
  • Fax:
Mailing address:
  • Phone: 989-944-8023
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code342000000X
TaxonomyTransportation Network Company
License NumberB639762453000
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: