Provider Demographics
NPI:1447213970
Name:BEESLEY, BRIAN J (DO)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:J
Last Name:BEESLEY
Suffix:
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 1:100 W 3RD AVE
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43201-3256
Mailing Address - Country:US
Mailing Address - Phone:614-299-2557
Mailing Address - Fax:614-299-9311
Practice Address - Street 1:815 W BROAD ST STE 350
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43222-1464
Practice Address - Country:US
Practice Address - Phone:614-223-1532
Practice Address - Fax:614-223-1732
Is Sole Proprietor?:No
Enumeration Date:2006-04-07
Last Update Date:2021-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34006643207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2081590Medicaid
G76432Medicare UPIN
OH2081590Medicaid