Provider Demographics
NPI:1073527081
Name:BEATY, JAMES TODD (DPM)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:TODD
Last Name:BEATY
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:115 PIRIE RD STE A
Mailing Address - Street 2:
Mailing Address - City:OJAI
Mailing Address - State:CA
Mailing Address - Zip Code:93023-3100
Mailing Address - Country:US
Mailing Address - Phone:805-646-7163
Mailing Address - Fax:805-646-7164
Practice Address - Street 1:115 PIRIE RD STE A
Practice Address - Street 2:
Practice Address - City:OJAI
Practice Address - State:CA
Practice Address - Zip Code:93023-3100
Practice Address - Country:US
Practice Address - Phone:805-646-7163
Practice Address - Fax:805-646-7164
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-27
Last Update Date:2009-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE4302213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA000E43020Medicaid
CAU82801Medicare UPIN
CA000E43020Medicaid
CAE4302Medicare PIN