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General NPI Number Information
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NPI Number | 1841825791
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Entity Type | Organization
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Legal Business Name | BEAL DERMATOLOGY, PLLC
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Dates
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Enumeration Date | 03/10/2020
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Last Update Date | 08/06/2024
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Provider Practice Location Address
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Address Line | 6817 SOUTHPOINT PKWY STE 101
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City | JACKSONVILLE
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State | FL
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Zip | 32216-6285
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Country | US
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Telephone | 904-420-7372
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Fax | 904-914-9231
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Provider Business Mailing Address
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Address Line | 6817 SOUTHPOINT PKWY STE 101
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City | JACKSONVILLE
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State | FL
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Zip | 32216-6285
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Country | US
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Telephone | 904-420-7372
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Fax | 904-914-9231
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Authorized Official
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Title or Position | MANAGER
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Name | BRANDON T BEAL
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Credential | MD
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Telephone | 314-422-6882
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207NP0225X
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Taxonomy Name | Pediatric Dermatology Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207NS0135X
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Taxonomy Name | Procedural Dermatology Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 207ND0101X
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Taxonomy Name | MOHS-Micrographic Surgery Physician
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License Number |
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Taxonomy #4
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Taxonomy Code | 207ND0900X
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Taxonomy Name | Dermatopathology Physician
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License Number |
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Taxonomy #5
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number |
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License Number State |
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