MEDICARE: DR. JASON GREGORY BEASLEY 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	18440	MS

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

General Provider Information

NPI Number	:	1508860214
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JASON GREGORY BEASLEY M.D.

Provider Business Mailing Address
First Line	:	606 GERALD MCRANEY ST
Second Line	:
City	:	COLLINS
State	:	MS
Zip	:	39428-3801
Country	:	US
Telephone Number	:	601-765-9393
Fax Number	:	601-765-9363

Provider Business Practice Location Address
First Line	:	603 S HOLLY AVE
Second Line	:
City	:	COLLINS
State	:	MS
Zip	:	39428-3801
Country	:	US
Telephone Number	:	601-765-9393
Fax Number	:	601-765-9363

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

Provider Enumeration Date	:	06/09/2005
Last Update Date	:	03/07/2023

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