Provider Demographics
NPI:1184672107
Name:BEACH, JEFFREY CORBETT (MD)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:CORBETT
Last Name:BEACH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 6069
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46206-6069
Mailing Address - Country:US
Mailing Address - Phone:317-844-5656
Mailing Address - Fax:317-575-3795
Practice Address - Street 1:12065 OLD MERIDIAN STREET
Practice Address - Street 2:SUITE 205
Practice Address - City:CARMEL
Practice Address - State:IN
Practice Address - Zip Code:46032
Practice Address - Country:US
Practice Address - Phone:317-844-5656
Practice Address - Fax:317-575-3795
Is Sole Proprietor?:No
Enumeration Date:2006-05-04
Last Update Date:2011-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01057410A207YX0905X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207YX0905XAllopathic & Osteopathic PhysiciansOtolaryngologyOtolaryngology/Facial Plastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
H96428Medicare UPIN
IN079890HMedicare ID - Type Unspecified
INH96428Medicare UPIN