MEDICARE: DR. KENT A BEAMS 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	01057486A	IN

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	:	1780682062
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KENT A BEAMS M.D.

Provider Business Mailing Address
First Line	:	14060 BISCAYNE BLVD APT 814
Second Line	:
City	:	NORTH MIAMI BEACH
State	:	FL
Zip	:	33181-1566
Country	:	US
Telephone Number	:	812-325-3275
Fax Number	:	786-565-9386

Provider Business Practice Location Address
First Line	:	6950 S PEARL DR
Second Line	:
City	:	CHANDLER
State	:	AZ
Zip	:	85249
Country	:	US
Telephone Number	:	812-325-3275
Fax Number	:	480-207-6307

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

Provider Enumeration Date	:	07/12/2005
Last Update Date	:	07/16/2018

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