Healthcare Provider Details

I. General information

NPI: 1437150117
Provider Name (Legal Business Name): KEITH ALAN BEAUCHAMP D.P.M.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/03/2005
Last Update Date: 08/08/2023
Certification Date: 08/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

106 BUTLER ST SUITE A
MACON MO
63552-1629
US

IV. Provider business mailing address

106 BUTLER ST P.O. BOX 447
MACON MO
63552-1629
US

V. Phone/Fax

Practice location:
  • Phone: 660-385-4464
  • Fax: 660-385-1449
Mailing address:
  • Phone: 660-385-4464
  • Fax: 660-385-1449

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number000737
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: