Provider Demographics
NPI:1003068214
Name:BEAMS, LEANDER JOSTIN SR
Entity Type:Individual
Prefix:MR
First Name:LEANDER
Middle Name:JOSTIN
Last Name:BEAMS
Suffix:SR
Gender:M
Credentials:
Other - Prefix:MR
Other - First Name:LEANDER
Other - Middle Name:JOSTIN
Other - Last Name:BEAMS
Other - Suffix:SR
Other - Last Name Type:Other Name
Other - Credentials:IDC
Mailing Address - Street 1:USS ANNAPOLIS SSN 760
Mailing Address - Street 2:
Mailing Address - City:FPO
Mailing Address - State:AE
Mailing Address - Zip Code:09564-2416
Mailing Address - Country:US
Mailing Address - Phone:860-694-3550
Mailing Address - Fax:
Practice Address - Street 1:USS ANNAPOLIS SSN 760
Practice Address - Street 2:
Practice Address - City:FPO
Practice Address - State:AE
Practice Address - Zip Code:09564-2416
Practice Address - Country:US
Practice Address - Phone:860-694-3550
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-21
Last Update Date:2008-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman