Provider Demographics
NPI:1295830917
Name:BEAMAN, DOUGLAS NEAL (MD)
Entity Type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:NEAL
Last Name:BEAMAN
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 1:501 N GRAHAM ST STE 250
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97227-1651
Mailing Address - Country:US
Mailing Address - Phone:503-249-0719
Mailing Address - Fax:503-249-0749
Practice Address - Street 1:501 N GRAHAM ST
Practice Address - Street 2:SUITE 250
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97227
Practice Address - Country:US
Practice Address - Phone:503-249-0719
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-14
Last Update Date:2018-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD19491174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500400380Medicaid
OR136940Medicare PIN
OR500400380Medicaid