Healthcare Provider Details

I. General information

NPI: 1265630941
Provider Name (Legal Business Name): RUSSELL OGDEN BEECHER D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/05/2007
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

335 N FAIRGROUNDS RD
PRICE UT
84501-4208
US

IV. Provider business mailing address

335 N FAIRGROUNDS RD
PRICE UT
84501-4208
US

V. Phone/Fax

Practice location:
  • Phone: 435-613-7246
  • Fax: 435-613-7247
Mailing address:
  • Phone: 435-613-7246
  • Fax: 435-613-7247

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number2007016063
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: