Healthcare Provider Details

I. General information

NPI: 1164530952
Provider Name (Legal Business Name): DOUGLAS W. BEAL, MD AND ASSOCIATES, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/29/2006
Last Update Date: 01/05/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2412 FORUM BLVD SUITE 201
COLUMBIA MO
65203-6364
US

IV. Provider business mailing address

2412 FORUM BLVD SUITE 201
COLUMBIA MO
65203-6364
US

V. Phone/Fax

Practice location:
  • Phone: 573-445-0725
  • Fax: 573-445-1027
Mailing address:
  • Phone: 573-445-0725
  • Fax: 573-445-1027

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. DOUGLAS WAYNE BEAL
Title or Position: PRESIDENT
Credential: M.D., M.S.H.A.
Phone: 573-445-0725