Provider Demographics
NPI:1063470219
Name:BEESLEY, ELLIS NORMAN JR (MD)
Entity Type:Individual
Prefix:DR
First Name:ELLIS
Middle Name:NORMAN
Last Name:BEESLEY
Suffix:JR
Gender:M
Credentials:MD
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Mailing Address - Street 1:1127 WILSHIRE BLVD
Mailing Address - Street 2:SUITE 707
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90017-3901
Mailing Address - Country:US
Mailing Address - Phone:213-482-4830
Mailing Address - Fax:213-482-0275
Practice Address - Street 1:1127 WILSHIRE BLVD
Practice Address - Street 2:SUITE 707
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90017-3901
Practice Address - Country:US
Practice Address - Phone:213-482-4830
Practice Address - Fax:213-482-0275
Is Sole Proprietor?:No
Enumeration Date:2006-05-03
Last Update Date:2021-07-21
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAA415482080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
A29402Medicare UPIN