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General NPI Number Information
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NPI Number | 1255378238
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Entity Type | Individual
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Provider Name | MITCHELL DREW BEATUS MD
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Gender | Male
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Dates
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Enumeration Date | 05/31/2006
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Last Update Date | 08/31/2011
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Provider Practice Location Address
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Address Line | 6019 WALNUT GROVE RD
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City | MEMPHIS
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State | TN
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Zip | 38120
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Country | US
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Telephone | 901-767-3123
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Fax | 901-767-3884
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Provider Business Mailing Address
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Address Line | P O BOX 1000 DEPT 0364
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City | MEMPHIS
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State | TN
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Zip | 38148-0364
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Country | US
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Telephone | 901-767-3123
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Fax | 901-767-3884
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RI0200X
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Taxonomy Name | Infectious Disease Physician
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License Number | MD26466
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License Number State | TN
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