Healthcare Provider Details

I. General information

NPI: 1669764106
Provider Name (Legal Business Name): GARY S BEASLEY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/03/2011
Last Update Date: 09/02/2025
Certification Date: 09/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 HAWKINS DR
IOWA CITY IA
52242-1009
US

IV. Provider business mailing address

200 HAWKINS DR
IOWA CITY IA
52242-1009
US

V. Phone/Fax

Practice location:
  • Phone: 319-356-2229
  • Fax: 319-384-7452
Mailing address:
  • Phone: 319-356-2229
  • Fax: 319-384-7452

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0202X
TaxonomyPediatric Cardiology Physician
License NumberMD-49578
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: