Provider Demographics
NPI:1235278748
Name:BEASLEY, LAWRENCE BURTON (MD)
Entity Type:Individual
Prefix:DR
First Name:LAWRENCE
Middle Name:BURTON
Last Name:BEASLEY
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 1:563 OLD CAROLEEN RD
Mailing Address - Street 2:
Mailing Address - City:FOREST CITY
Mailing Address - State:NC
Mailing Address - Zip Code:28043-3773
Mailing Address - Country:US
Mailing Address - Phone:828-248-1373
Mailing Address - Fax:828-248-1058
Practice Address - Street 1:563 OLD CAROLEEN RD
Practice Address - Street 2:
Practice Address - City:FOREST CITY
Practice Address - State:NC
Practice Address - Zip Code:28043-3773
Practice Address - Country:US
Practice Address - Phone:828-248-1373
Practice Address - Fax:828-248-1058
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC39236174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist