Healthcare Provider Details

I. General information

NPI: 1427342435
Provider Name (Legal Business Name): BRADY DUTTON BEECHAM MD, MPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/07/2011
Last Update Date: 06/18/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1201 N ERIE ST
LEXINGTON NE
68850-1560
US

IV. Provider business mailing address

1201 N ERIE ST PO BOX 980
LEXINGTON NE
68850-1560
US

V. Phone/Fax

Practice location:
  • Phone: 308-324-8317
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberMT200231
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMT200231
License Number StatePA
# 3
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number27904
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: