MEDICARE: DR. GALE ROLLAND BEARDSLEY JR. 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	2084P0800X	Psychiatry Physician	MD4083	HI
2	2084P0800X	Psychiatry Physician	G151697	CA

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	:	1790789600
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GALE ROLLAND BEARDSLEY JR. M.D.

Provider Business Mailing Address
First Line	:	1629 WILDER AVE APT 704
Second Line	:
City	:	HONOLULU
State	:	HI
Zip	:	96822-4666
Country	:	US
Telephone Number	:	808-721-7278
Fax Number	:	808-207-3799

Provider Business Practice Location Address
First Line	:	1629 WILDER AVE APT 704
Second Line	:
City	:	HONOLULU
State	:	HI
Zip	:	96822-4666
Country	:	US
Telephone Number	:	808-721-7278
Fax Number	:	808-207-3799

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

Provider Enumeration Date	:	06/08/2005
Last Update Date	:	05/07/2021

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Directions to “ DR. GALE ROLLAND BEARDSLEY JR. M.D.” Practice Location

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