Provider Demographics
NPI:1073598058
Name:BEEZLEY, JON THOMAS (DO)
Entity Type:Individual
Prefix:DR
First Name:JON
Middle Name:THOMAS
Last Name:BEEZLEY
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 1:2804 HIGH POINT CT
Mailing Address - Street 2:
Mailing Address - City:GRAPEVINE
Mailing Address - State:TX
Mailing Address - Zip Code:76051-6460
Mailing Address - Country:US
Mailing Address - Phone:817-488-9124
Mailing Address - Fax:
Practice Address - Street 1:800 W RANDOL MILL RD
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76012-2504
Practice Address - Country:US
Practice Address - Phone:817-548-6205
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-13
Last Update Date:2013-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL0025207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1978868Medicaid
TX8J1862OtherBCBS
LA1451088Medicaid
TX8A0465OtherBCBS
TX8A3020OtherBCBS
TX930096176OtherRAILROAD
TX047360501Medicaid
TX047360511Medicaid
TXP00148168OtherRAILROAD
TX930094840OtherRAILROAD
TX930096177OtherMEDICARE RAILROAD
TXP01170066OtherRAILROAD MCARE
TX047360506Medicaid
TX8BT311OtherBCBS THRU SAEMA
TX8A3030OtherBCBS
TX047360501Medicaid
TX8924J9Medicare PIN
TX8974J2Medicare PIN
TXP00148168OtherRAILROAD
TX8A3020OtherBCBS
TX8J1862OtherBCBS