Healthcare Provider Details

I. General information

NPI: 1245289958
Provider Name (Legal Business Name): JAMES LEBER BEALL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/09/2006
Last Update Date: 08/13/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1441 N BECKLEY AVE
DALLAS TX
75203-1201
US

IV. Provider business mailing address

1750 NORTH HAMPTON ROAD
DESOTO TX
75115
US

V. Phone/Fax

Practice location:
  • Phone: 214-946-4397
  • Fax: 214-946-4399
Mailing address:
  • Phone: 214-946-4397
  • Fax: 214-946-4399

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberF5464
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: