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General NPI Number Information
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NPI Number | 1265997225
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Entity Type | Individual
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Provider Name | JOSEPH ROSS BEACH III PA-C
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Gender | Male
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Dates
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Enumeration Date | 02/04/2019
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Last Update Date | 04/04/2023
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Provider Practice Location Address
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Address Line | 20333 N 19TH AVE STE 100
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City | PHOENIX
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State | AZ
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Zip | 85027-3602
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Country | US
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Telephone | 623-516-8252
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Fax | 623-516-8253
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Provider Business Mailing Address
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Address Line | 5281 N 99TH AVE STE 100
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City | GLENDALE
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State | AZ
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Zip | 85305-2209
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Country | US
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Telephone | 623-516-8252
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Fax | 623-516-8253
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 7456
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License Number State | AZ
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Taxonomy #2
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Taxonomy Code | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number |
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License Number State |
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