MEDICARE: LESLIE BEAM

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	363A00000X	Physician Assistant	PA05450	TX

General Provider Information

NPI Number	:	1487049904
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LESLIE BEAM

Provider Business Mailing Address
First Line	:	17515 LORING LN
Second Line	:
City	:	SPRING
State	:	TX
Zip	:	77388-9704
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3313 ORLANDO ST
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77093-4854
Country	:	US
Telephone Number	:	713-699-9177
Fax Number	:

Authorized Official
Title or Position	:	PHYSICIAN ASSISTANT
Name	:	MS. LESLIE A BEAM
Credential	:	P.A.C
Telephone Number	:	623-229-2116

Provider Enumeration Date	:	04/01/2015
Last Update Date	:	04/01/2015

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Directions to “LESLIE BEAM ” Practice Location

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