MEDICARE: MORGAN T BEAMAN MFN, RD, LD

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	133V00000X	Registered Dietitian	2021024940	MO

General Provider Information

NPI Number	:	1770267049
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MORGAN T BEAMAN MFN, RD, LD

Provider Business Mailing Address
First Line	:	24 S GORE AVE
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63119-2910
Country	:	US
Telephone Number	:	314-717-5195
Fax Number	:	618-209-1962

Provider Business Practice Location Address
First Line	:	24 S GORE AVE
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63119-2910
Country	:	US
Telephone Number	:	314-804-1848
Fax Number	:	618-209-1962

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

Provider Enumeration Date	:	06/14/2023
Last Update Date	:	06/14/2023

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