Healthcare Provider Details

I. General information

NPI: 1366414823
Provider Name (Legal Business Name): ALLEN N BEARDSLEY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/07/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

115 4TH AVE W
HAVRE MT
59501-3456
US

IV. Provider business mailing address

PO BOX 1231
HAVRE MT
59501-1231
US

V. Phone/Fax

Practice location:
  • Phone: 406-265-9636
  • Fax: 406-265-1651
Mailing address:
  • Phone: 406-262-1305
  • Fax: 406-265-1651

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number4316
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: