MEDICARE: LESLIE A. BEAM PA

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	363A00000X	Physician Assistant	3346	AZ
2	363A00000X	Physician Assistant	PA05450	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	3346	OTHER	AZ	PHYSICIAN ASSIST. LIC.

General Provider Information

NPI Number	:	1891744132
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LESLIE A. BEAM PA

Provider Business Mailing Address
First Line	:	3313 ORLANDO ST
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77093-4854
Country	:	US
Telephone Number	:	713-699-9177
Fax Number	:

Provider Business Practice Location Address
First Line	:	3313 ORLANDO ST
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77093-4854
Country	:	US
Telephone Number	:	713-699-9177
Fax Number	:

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

Provider Enumeration Date	:	05/05/2006
Last Update Date	:	04/30/2018

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