Provider Demographics
NPI:1306866041
Name:BEASON, BILL J (MD)
Entity Type:Individual
Prefix:DR
First Name:BILL
Middle Name:J
Last Name:BEASON
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 1:237 LONGVUE DR.
Mailing Address - Street 2:#C
Mailing Address - City:BOONE
Mailing Address - State:NC
Mailing Address - Zip Code:28607-5070
Mailing Address - Country:US
Mailing Address - Phone:828-264-4533
Mailing Address - Fax:828-264-2454
Practice Address - Street 1:237 LONGVUE DR
Practice Address - Street 2:#C
Practice Address - City:BOONE
Practice Address - State:NC
Practice Address - Zip Code:28607-5070
Practice Address - Country:US
Practice Address - Phone:828-264-4533
Practice Address - Fax:828-264-2454
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC00-23465207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8914159Medicaid
NC202232Medicare ID - Type Unspecified
NCC85758Medicare UPIN