Provider Demographics
NPI:1427002799
Name:BEAMAN, RODERICK T JR (DO)
Entity Type:Individual
Prefix:
First Name:RODERICK
Middle Name:T
Last Name:BEAMAN
Suffix:JR
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 1:8761 PERIMETER PARK BLVD SUITE 101
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32216
Mailing Address - Country:US
Mailing Address - Phone:904-724-5767
Mailing Address - Fax:904-724-5770
Practice Address - Street 1:8761 PERIMETER PARK BLVD SUITE 101
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32216
Practice Address - Country:US
Practice Address - Phone:904-724-5767
Practice Address - Fax:904-724-5770
Is Sole Proprietor?:No
Enumeration Date:2006-05-20
Last Update Date:2019-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS8811207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLB57981Medicare UPIN