Provider Demographics
NPI:1104825439
Name:BEEBE, JACK E (MD)
Entity Type:Individual
Prefix:DR
First Name:JACK
Middle Name:E
Last Name:BEEBE
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:PO BOX 1074
Mailing Address - Street 2:C/O ANESTHESIA ASSOCIATES OF DUNEDIN
Mailing Address - City:DUNEDIN
Mailing Address - State:FL
Mailing Address - Zip Code:34697-1074
Mailing Address - Country:US
Mailing Address - Phone:727-734-6516
Mailing Address - Fax:727-734-4516
Practice Address - Street 1:601 MAIN ST
Practice Address - Street 2:STE 205
Practice Address - City:DUNEDIN
Practice Address - State:FL
Practice Address - Zip Code:34698-5848
Practice Address - Country:US
Practice Address - Phone:727-734-6516
Practice Address - Fax:727-734-4516
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME 20500207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL78125OtherBCBS OF FLORIDA
D58373Medicare UPIN
FL78125ZMedicare ID - Type Unspecified