Healthcare Provider Details

I. General information

NPI: 1811065436
Provider Name (Legal Business Name): EARL C. BEEKS JR. M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/01/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8420 DELMAR BLVD SUITE 402
UNIVERSITY CITY MO
63124
US

IV. Provider business mailing address

8420 DELMAR BLVD SUITE 402
UNIVERSITY CITY MO
63124
US

V. Phone/Fax

Practice location:
  • Phone: 314-567-3232
  • Fax: 314-567-5380
Mailing address:
  • Phone: 314-567-3232
  • Fax: 314-567-5380

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number36260
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: