Provider Demographics
NPI:1053053603
Name:BEAUCHAMP, JOSHUA DANE
Entity Type:Individual
Prefix:
First Name:JOSHUA
Middle Name:DANE
Last Name:BEAUCHAMP
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13727 S BUCKEYE VIEW WAY
Mailing Address - Street 2:
Mailing Address - City:RIVERTON
Mailing Address - State:UT
Mailing Address - Zip Code:84096-7250
Mailing Address - Country:US
Mailing Address - Phone:208-313-7518
Mailing Address - Fax:
Practice Address - Street 1:1273 W 12600 S STE 403
Practice Address - Street 2:
Practice Address - City:RIVERTON
Practice Address - State:UT
Practice Address - Zip Code:84065-7111
Practice Address - Country:US
Practice Address - Phone:801-930-0411
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-12
Last Update Date:2022-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program