Healthcare Provider Details

I. General information

NPI: 1558463463
Provider Name (Legal Business Name): NATHAN LEWIS BEUCKE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/01/2006
Last Update Date: 08/15/2024
Certification Date: 08/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

551 VETERANS UNITED DR
COLUMBIA MO
65201-8397
US

IV. Provider business mailing address

PO BOX 843966
KANSAS CITY MO
64184-3966
US

V. Phone/Fax

Practice location:
  • Phone: 573-882-4730
  • Fax: 573-884-4899
Mailing address:
  • Phone: 573-884-3300
  • Fax: 573-884-0943

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number2007016198
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: