Healthcare Provider Details

I. General information

NPI: 1104856087
Provider Name (Legal Business Name): BRYAN JAMES BEARDSLEY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/04/2006
Last Update Date: 06/24/2026
Certification Date: 06/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1207 EVERGREEN CT
CLARKSTON WA
99403-2874
US

IV. Provider business mailing address

PO BOX 189
CLARKSTON WA
99403-0189
US

V. Phone/Fax

Practice location:
  • Phone: 509-769-2255
  • Fax: 509-769-2255
Mailing address:
  • Phone: 509-769-2254
  • Fax: 509-769-2255

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberM9722
License Number StateID
# 2
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberMD00044939
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: