Provider Demographics
NPI:1477580330
Name:BEASLEY, THOMAS J (MD)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:J
Last Name:BEASLEY
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:PO BOX 1617
Mailing Address - Street 2:
Mailing Address - City:FORREST CITY
Mailing Address - State:AR
Mailing Address - Zip Code:72336-1617
Mailing Address - Country:US
Mailing Address - Phone:870-633-7742
Mailing Address - Fax:870-633-9003
Practice Address - Street 1:1204 N WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:FORREST CITY
Practice Address - State:AR
Practice Address - Zip Code:72335-2121
Practice Address - Country:US
Practice Address - Phone:870-633-7742
Practice Address - Fax:870-633-9003
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-27
Last Update Date:2008-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARN5884207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR50361OtherBCBS PROVIDER NUMBER
AR50361OtherMEDICARE PROVIDER NUMBER
AR50361OtherBCBS PROVIDER NUMBER
AR50361OtherMEDICARE PROVIDER NUMBER