Provider Demographics
NPI:1063490548
Name:BEAMSLEY, ALAN CRAIG (DO)
Entity Type:Individual
Prefix:
First Name:ALAN
Middle Name:CRAIG
Last Name:BEAMSLEY
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1010 MILDA AVE
Mailing Address - Street 2:
Mailing Address - City:GALLUP
Mailing Address - State:NM
Mailing Address - Zip Code:87301-7022
Mailing Address - Country:US
Mailing Address - Phone:505-870-1256
Mailing Address - Fax:
Practice Address - Street 1:1010 MILDA AVE
Practice Address - Street 2:
Practice Address - City:GALLUP
Practice Address - State:NM
Practice Address - Zip Code:87301-7022
Practice Address - Country:US
Practice Address - Phone:505-870-1256
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-05
Last Update Date:2015-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMA806-85207P00000X
WI18056207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
85031326887301A111OtherCHAMPUS
NM40741Medicaid
NMNM007580OtherBC/BS
NMPROVP11304OtherMOLINA
NM10002096OtherLOVELACE HEALTH/SALUD
NM930011681OtherRAILROAD MEDICARE
NM201014076OtherPRESBYTERIAN HEALTH/SALUD
AZ315483OtherAHCCCS
NMNM007580OtherBC/BS
NMPROVP11304OtherMOLINA