Provider Demographics
NPI:1003120262
Name:BEAL, CASEY JUSTIN (MD)
Entity Type:Individual
Prefix:DR
First Name:CASEY
Middle Name:JUSTIN
Last Name:BEAL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 100284
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32610-0284
Mailing Address - Country:US
Mailing Address - Phone:352-273-8878
Mailing Address - Fax:352-273-7402
Practice Address - Street 1:1600 SW ARCHER RD
Practice Address - Street 2:BOX 100284
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32610-0284
Practice Address - Country:US
Practice Address - Phone:352-273-8778
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-07-29
Last Update Date:2020-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN7218207W00000X
390200000X
FLME120238207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL012369300Medicaid
FLHV828ZMedicare PIN