Healthcare Provider Details

I. General information

NPI: 1386642577
Provider Name (Legal Business Name): JOHN K BEIGHLE DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/12/2005
Last Update Date: 12/20/2024
Certification Date: 12/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1801 SELWAY DR
MISSOULA MT
59808-9314
US

IV. Provider business mailing address

1801 SELWAY DR
MISSOULA MT
59808-9314
US

V. Phone/Fax

Practice location:
  • Phone: 406-240-4593
  • Fax:
Mailing address:
  • Phone: 406-240-4593
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number219938
License Number StateMT
# 2
Primary TaxonomyN
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number113
License Number StateMT
# 3
Primary TaxonomyN
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License Number113
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: