Provider Demographics
NPI:1164530952
Name:DOUGLAS W. BEAL, MD AND ASSOCIATES, PC
Entity Type:Organization
Organization Name:DOUGLAS W. BEAL, MD AND ASSOCIATES, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:WAYNE
Authorized Official - Last Name:BEAL
Authorized Official - Suffix:
Authorized Official - Credentials:MD, MSHA
Authorized Official - Phone:573-445-0725
Mailing Address - Street 1:2412 FORUM BLVD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65203-6364
Mailing Address - Country:US
Mailing Address - Phone:573-445-0725
Mailing Address - Fax:573-445-1027
Practice Address - Street 1:2412 FORUM BLVD
Practice Address - Street 2:SUITE 201
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65203-6364
Practice Address - Country:US
Practice Address - Phone:573-445-0725
Practice Address - Fax:573-445-1027
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-29
Last Update Date:2014-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty