Healthcare Provider Details

I. General information

NPI: 1003178674
Provider Name (Legal Business Name): STEVEN D. BEESLEY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/11/2012
Last Update Date: 07/03/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

86 W UNDERWOOD ST SUITE 201, 2ND FLOOR
ORLANDO FL
32806-1110
US

IV. Provider business mailing address

PO BOX 9007
CHARLOTTESVILLE VA
22906-9007
US

V. Phone/Fax

Practice location:
  • Phone: 321-841-5142
  • Fax: 407-648-3686
Mailing address:
  • Phone: 434-295-1000
  • Fax: 434-972-4266

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number0101261934
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberTRN17647
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: