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General NPI Number Information
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NPI Number | 1528080686
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Entity Type | Individual
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Provider Name | GARY D BEAUCHAMP MD
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Gender | Male
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Dates
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Enumeration Date | 07/24/2006
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Last Update Date | 12/18/2013
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Provider Practice Location Address
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Address Line | 1530 N CHURCH RD
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City | LIBERTY
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State | MO
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Zip | 64068-7129
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Country | US
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Telephone | 816-781-1696
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Fax | 816-781-5438
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Provider Business Mailing Address
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Address Line | 5501 NW 62ND TER SUITE 201
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City | KANSAS CITY
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State | MO
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Zip | 64151-2411
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Country | US
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Telephone | 816-584-8884
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Fax | 913-588-9220
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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 | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number | R5969
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License Number State | MO
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Taxonomy #2
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number | 04-14844
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License Number State | KS
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