Blake Richard Beazer MD

NPI 1073510012 - Family Medicine - 207Q00000X

NPI Details
NPI 1073510012
Gender Male
Enumeration Date 07/06/2005
Last Updated 03/21/2014
Entity Type Individual
Active Over 11 years ago
Practice Location
2356 N 400 E
STE 201
TOOELE UT, 84074, US
Phone (435) 882-2350
Fax (435) 882-2039
Business Location
2356 N 400 E
STE 201
TOOELE UT, 84074, US
Phone (435) 882-2350
Fax (435) 882-2039
Toxanomy
Taxonomy Code 207Q00000X
License State Utah
License Number 5248080-1205
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According to our database, Blake Richard Beazer MD NPI is 1073510012, taxonomy code is 207Q00000X and license number is 5248080-1205, license state is located at Utah. Blake Richard Beazer MD physically located at 2356 N 400 E, Tooele UT, 84074. NPI Number Blake Richard Beazer MD has the Individual type.

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1073510012 NPI number is provided on an as is basis without warranty of any kind. 1073510012 is maintained by the National Plan & Provider Enumeration System. The contents of Blake Richard Beazer MD are for informational purposes only.