Healthcare Provider Details

I. General information

NPI: 1902291784
Provider Name (Legal Business Name): BRANDON TYLER BEAL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/30/2015
Last Update Date: 05/10/2026
Certification Date: 05/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

520 E CHERRY ST
TROY MO
63379-1410
US

IV. Provider business mailing address

520 E CHERRY ST
TROY MO
63379-1410
US

V. Phone/Fax

Practice location:
  • Phone: 314-834-1400
  • Fax: 314-834-1430
Mailing address:
  • Phone: 314-834-1400
  • Fax: 314-834-1430

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207NS0135X
TaxonomyProcedural Dermatology Physician
License Number2022006729
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code207ND0101X
TaxonomyMOHS-Micrographic Surgery Physician
License Number2022006729
License Number StateMO
# 3
Primary TaxonomyN
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number2022006729
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: