Provider Demographics
NPI:1427015510
Name:BEESON, MARY (MD)
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:
Last Name:BEESON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:417 CORBETT ST
Mailing Address - Street 2:
Mailing Address - City:BELLEAIR
Mailing Address - State:FL
Mailing Address - Zip Code:33756-3305
Mailing Address - Country:US
Mailing Address - Phone:727-441-4581
Mailing Address - Fax:727-443-2307
Practice Address - Street 1:417 CORBETT STREET
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33756
Practice Address - Country:US
Practice Address - Phone:727-441-4581
Practice Address - Fax:727-443-2307
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-01
Last Update Date:2017-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME75313207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
H59700Medicare UPIN
FL62789Medicare PIN