Healthcare Provider Details

I. General information

NPI: 1679508147
Provider Name (Legal Business Name): DAVID BEARDSWORTH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/12/2006
Last Update Date: 07/27/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1167 E 22ND AVE
EUGENE OR
97403-1508
US

IV. Provider business mailing address

1167 E 22ND AVE
EUGENE OR
97403-1508
US

V. Phone/Fax

Practice location:
  • Phone: 541-228-0177
  • Fax:
Mailing address:
  • Phone: 541-228-0177
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberMD18599
License Number StateOR

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier287965
Identifier TypeMEDICAID
Identifier StateOR
Identifier Issuer
# 2
IdentifierA044
Identifier TypeOTHER
Identifier StateOR
Identifier IssuerTRICARE
# 3
Identifier050077189
Identifier TypeOTHER
Identifier StateOR
Identifier IssuerRAILROAD MEDICARE
# 4
IdentifierR107984
Identifier TypeOTHER
Identifier StateOR
Identifier IssuerMEDICARE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: