MEDICARE: DR. DAVID B BEESON M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	01033731A	IN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	10815088	OTHER		CAQH

General Provider Information

NPI Number	:	1033190483
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DAVID B BEESON M.D.

Provider Business Mailing Address
First Line	:	1251 KEM ROAD
Second Line	:	SUITE E
City	:	MARION
State	:	IN
Zip	:	46952-2555
Country	:	US
Telephone Number	:	765-662-4133
Fax Number	:	765-651-7313

Provider Business Practice Location Address
First Line	:	4781 KAYBEE DR
Second Line	:
City	:	GAS CITY
State	:	IN
Zip	:	46933-6607
Country	:	US
Telephone Number	:	765-998-9980
Fax Number	:	765-998-9984

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/10/2005
Last Update Date	:	02/19/2009

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