MEDICARE: DELBERT H BEAUCHAMP JR. PA-C

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	363AS0400X	Surgical Physician Assistant	PA00653	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	88N110	OTHER	TX	BCBS
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1205938800
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DELBERT H BEAUCHAMP JR. PA-C

Provider Business Mailing Address
First Line	:	PO BOX 2550
Second Line	:
City	:	ROWLETT
State	:	TX
Zip	:	75030-2550
Country	:	US
Telephone Number	:	214-227-2457
Fax Number	:	214-227-2457

Provider Business Practice Location Address
First Line	:	2150 S CENTRAL EXPY
Second Line	:	STE 130
City	:	MCKINNEY
State	:	TX
Zip	:	75070-4070
Country	:	US
Telephone Number	:	214-714-7010
Fax Number	:	972-363-8196

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

Provider Enumeration Date	:	09/02/2006
Last Update Date	:	05/31/2022

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