Healthcare Provider Details

I. General information

NPI: 1881795235
Provider Name (Legal Business Name): DIANE K BEEBE M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/26/2006
Last Update Date: 02/13/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 NORTH STATE STREET DEPT OF FAMILY MEDICINE
JACKSON MS
39216
US

IV. Provider business mailing address

2500 N STATE ST
JACKSON MS
39216-4500
US

V. Phone/Fax

Practice location:
  • Phone: 601-984-6800
  • Fax: 601-984-6812
Mailing address:
  • Phone: 601-815-4778
  • Fax: 601-984-5420

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number10757
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: