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1609881036

NPI Code Detail

MEDICARE: BRUCE W BEAUCHAMP DO

MEDICARE: BRUCE W BEAUCHAMP DO

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	207L00000X	Anesthesiology Physician	16476	OR
2	207L00000X	Anesthesiology Physician	1260	WA
3	207L00000X	Anesthesiology Physician	10096	ND
4	207L00000X	Anesthesiology Physician	5697	AK
5	207L00000X	Anesthesiology Physician	3891	AZ
6	207L00000X	Anesthesiology Physician	0.198	ID
7	207L00000X	Anesthesiology Physician	1499	WV
8	207L00000X	Anesthesiology Physician	DO 116462	MO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	28761	OTHER	ND	ND BLUE CROSS BLUE SHIELD
2	1417978057	OTHER	MN	DEPT OF HUMAN SERVICES
3	A06171050226	OTHER	ND	PREFERRED ONE
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	20-03471	OTHER	ND	MEDICA

General Provider Information

NPI Number	:	1609881036
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRUCE W BEAUCHAMP DO

Provider Business Mailing Address
First Line	:	2521 DELORES LN
Second Line	:
City	:	NORTH BEND
State	:	OR
Zip	:	97459-1524
Country	:	US
Telephone Number	:	541-751-1434
Fax Number	:

Provider Business Practice Location Address
First Line	:	4021 S 700 E
Second Line	:	SUITE 220
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84107-2192
Country	:	US
Telephone Number	:	800-211-4971
Fax Number	:

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

Provider Enumeration Date	:	07/31/2006
Last Update Date	:	05/18/2010

Similar Medicare Providers

1417998659 — MR. BERNARD LARRY WEINSTEIN MD
Practice Location Address:

4021 S 700 E , SUITE 300
SALT LAKE CITY, UT
84107-2192

Practice Phone: 800-328-3035
Practice Fax: 801-284-6810

1134151368 — DR. EDWIN M. MARKS M.D.
Practice Location Address:

4021 S 700 E , SUITE 300
SALT LAKE CITY, UT
84107-2192

Practice Phone: 800-423-1605
Practice Fax: 801-284-6775

1720093123 — DR. JACQUELYN L TOTON M.D.
Practice Location Address:

4021 S 700 E , SUITE 300
SALT LAKE CITY, UT
84107-2192

Practice Phone: 800-328-3067
Practice Fax:

1184711897 — DR. ANTHONY E HOWES M.D.
Practice Location Address:

4021 S 700 E , 300
SALT LAKE CITY, UT
84107-2192

Practice Phone: 800-732-7176
Practice Fax: 801-284-6743

1699862060 — DR. RICHARD HARRY MCILROY JR. MD
Practice Location Address:

4021 S 700 E , SUITE 300
SALT LAKE CITY, UT
84107-2192

Practice Phone: 800-328-3048
Practice Fax: 801-264-6463

1164512216 — DR. WILLIAM SIEGEL MD
Practice Location Address:

4021 S 700 E , SUITE 300
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Practice Phone: 800-453-3030
Practice Fax:

Directions to “ BRUCE W BEAUCHAMP DO” Practice Location

Language	Start Address	Practice Location

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