Healthcare Provider Details

I. General information

NPI: 1326015546
Provider Name (Legal Business Name): DERRICK J. BEECH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/07/2006
Last Update Date: 10/02/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

85 MAUI LANI PKWY
WAILUKU HI
96793-2416
US

IV. Provider business mailing address

7080 CANONBURY PL
ATLANTA GA
30328-1934
US

V. Phone/Fax

Practice location:
  • Phone: 808-442-5700
  • Fax:
Mailing address:
  • Phone: 615-887-1114
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number056091
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code2086X0206X
TaxonomySurgical Oncology Physician
License Number53390
License Number StateAZ
# 3
Primary TaxonomyN
Taxonomy Code2086X0206X
TaxonomySurgical Oncology Physician
License Number056091
License Number StateGA
# 4
Primary TaxonomyY
Taxonomy Code2086X0206X
TaxonomySurgical Oncology Physician
License NumberMD-18903
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: