Provider Demographics
NPI:1306853700
Name:BEATROUS, THOMAS E (MD)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:E
Last Name:BEATROUS
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 1:1400 AFFLINK PL STE 100
Mailing Address - Street 2:
Mailing Address - City:TUSCALOOSA
Mailing Address - State:AL
Mailing Address - Zip Code:35406-2289
Mailing Address - Country:US
Mailing Address - Phone:205-366-9740
Mailing Address - Fax:205-344-9992
Practice Address - Street 1:300 SAINT LUKES DR
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36117-7102
Practice Address - Country:US
Practice Address - Phone:334-273-8877
Practice Address - Fax:334-273-9733
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2019-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL198602085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL051008209OtherBCBS AL/MONT EAST
AL009905565Medicaid
AL009914315Medicaid
AL000008209Medicaid
AL051008345OtherBCBS OF AL/SYLACAUGA
AL051511893OtherBCBS OF AL/MONT SOUTH
AL051512851OtherBCBS OF AL/SHELBY
AL51107953OtherBCBS OF AL/ANNISTON
AL009914315Medicaid
AL51107953OtherBCBS OF AL/ANNISTON
ALJ886Medicare ID - Type UnspecifiedGROUP
ALI938Medicare ID - Type UnspecifiedGROUP
ALE55936Medicare UPIN
AL009905565Medicaid