Provider Demographics
NPI:1053304808
Name:BEACH, JAMES (DO)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:
Last Name:BEACH
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:7725 N 43RD AVE
Mailing Address - Street 2:SUITE 111
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85051-5770
Mailing Address - Country:US
Mailing Address - Phone:623-931-9201
Mailing Address - Fax:623-931-2116
Practice Address - Street 1:7725 N 43RD AVE
Practice Address - Street 2:SUITE 111
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85051-5770
Practice Address - Country:US
Practice Address - Phone:623-931-9201
Practice Address - Fax:623-931-2116
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-26
Last Update Date:2014-10-29
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
AZ1438207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZE39795Medicare UPIN