Provider Demographics
NPI:1255317228
Name:BEAHAN, JOSEPH T (DO)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:T
Last Name:BEAHAN
Suffix:
Gender:M
Credentials:DO
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 409
Mailing Address - Street 2:
Mailing Address - City:PERRY
Mailing Address - State:MO
Mailing Address - Zip Code:63462-0409
Mailing Address - Country:US
Mailing Address - Phone:573-565-2213
Mailing Address - Fax:573-565-3517
Practice Address - Street 1:1223 E MAIN ST
Practice Address - Street 2:
Practice Address - City:PERRY
Practice Address - State:MO
Practice Address - Zip Code:63462-1410
Practice Address - Country:US
Practice Address - Phone:573-565-2213
Practice Address - Fax:573-565-3517
Is Sole Proprietor?:No
Enumeration Date:2005-12-21
Last Update Date:2008-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR3N97207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO242871309Medicaid
MO242871309Medicaid
MO001011725Medicare PIN
001011725Medicare ID - Type Unspecified