MEDICARE: WILLIAM THOMAS BEASLEY DPM

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	213E00000X	Podiatrist	126	KY
2	213E00000X	Podiatrist	07000339A	IN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	1054679	OTHER	PASSPORT
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1336140482
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WILLIAM THOMAS BEASLEY DPM

Provider Business Mailing Address
First Line	:	4602 SOUTHERN PKWY
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40214-1442
Country	:	US
Telephone Number	:	502-366-1479
Fax Number	:	502-366-6718

Provider Business Practice Location Address
First Line	:	4602 SOUTHERN PKWY
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40214-1442
Country	:	US
Telephone Number	:	502-366-1479
Fax Number	:	502-366-6718

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

Provider Enumeration Date	:	08/10/2005
Last Update Date	:	02/04/2013

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Directions to “ WILLIAM THOMAS BEASLEY DPM” Practice Location

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