Provider Demographics
NPI:1003831983
Name:BEAUCHAMP, RODNEY K (MD)
Entity Type:Individual
Prefix:MR
First Name:RODNEY
Middle Name:K
Last Name:BEAUCHAMP
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 1:200 PARKWEST CIR STE 2
Mailing Address - Street 2:
Mailing Address - City:DOTHAN
Mailing Address - State:AL
Mailing Address - Zip Code:36303-3069
Mailing Address - Country:US
Mailing Address - Phone:334-699-2004
Mailing Address - Fax:334-699-2006
Practice Address - Street 1:200 PARKWEST CIR STE 2
Practice Address - Street 2:
Practice Address - City:DOTHAN
Practice Address - State:AL
Practice Address - Zip Code:36303
Practice Address - Country:US
Practice Address - Phone:334-699-2004
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-13
Last Update Date:2018-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL00020759207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL511-59109OtherBLUE CROSS BLUE SHIELD AL
ALG57973Medicare UPIN
AL102I119509Medicare PIN