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General NPI Number Information
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NPI Number | 1609881036
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Entity Type | Individual
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Provider Name | BRUCE W BEAUCHAMP DO
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Gender | Male
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Dates
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Enumeration Date | 07/31/2006
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Last Update Date | 05/18/2010
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Provider Practice Location Address
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Address Line | 4021 S 700 E SUITE 220
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City | SALT LAKE CITY
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State | UT
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Zip | 84107-2192
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Country | US
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Telephone | 800-211-4971
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Fax |
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Provider Business Mailing Address
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Address Line | 2521 DELORES LN
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City | NORTH BEND
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State | OR
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Zip | 97459-1524
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Country | US
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Telephone | 541-751-1434
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Fax |
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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 | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | 16476
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License Number State | OR
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Taxonomy #2
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | 1260
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License Number State | WA
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Taxonomy #3
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | 10096
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License Number State | ND
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Taxonomy #4
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | 5697
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License Number State | AK
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Taxonomy #5
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | 3891
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License Number State | AZ
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Taxonomy #6
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | 0.198
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License Number State | ID
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Taxonomy #7
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | 1499
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License Number State | WV
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Taxonomy #8
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | DO 116462
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License Number State | MO
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