Provider Demographics
NPI:1508829177
Name:BEATTIE, JAMES VON (DO)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:VON
Last Name:BEATTIE
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:PO BOX 955534
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63195-5534
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:400 MEDICAL PLZ
Practice Address - Street 2:SUITE 100
Practice Address - City:LAKE ST LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63367-1490
Practice Address - Country:US
Practice Address - Phone:636-639-8600
Practice Address - Fax:636-639-8676
Is Sole Proprietor?:No
Enumeration Date:2006-04-06
Last Update Date:2020-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2000158289207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
P00050149OtherRR MEDICARE
189526OtherGHP
647447OtherHEALTHLINK
MO180221OtherBCBS
3600531OtherUHC
MO209118108Medicaid
7833546OtherAETNA
7833546OtherAETNA
MO990010983Medicare ID - Type Unspecified