Provider Demographics
NPI:1114215548
Name:YANCEY B BEAMER MD, INC
Entity Type:Organization
Organization Name:YANCEY B BEAMER MD, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:YANCEY
Authorized Official - Middle Name:B
Authorized Official - Last Name:BEAMER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:714-832-8020
Mailing Address - Street 1:PO BOX 571470
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84157-1470
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:14591 NEWPORT AVE.
Practice Address - Street 2:SUITE 106
Practice Address - City:TUSTIN
Practice Address - State:CA
Practice Address - Zip Code:92780-6026
Practice Address - Country:US
Practice Address - Phone:714-832-8020
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-19
Last Update Date:2011-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG16380207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Single Specialty