Healthcare Provider Details

I. General information

NPI: 1386605129
Provider Name (Legal Business Name): RICHARD E BEECHLY CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/31/2006
Last Update Date: 10/29/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2699 N 17TH ST
COOS BAY OR
97420
US

IV. Provider business mailing address

5319 SW WESTGATE DR 241
PORTLAND OR
97221-2432
US

V. Phone/Fax

Practice location:
  • Phone: 541-269-7358
  • Fax: 541-269-0677
Mailing address:
  • Phone: 503-297-7223
  • Fax: 503-297-7603

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number089006350
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: