Provider Demographics
NPI:1548229743
Name:BEAUVAIS, JOHN P (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:P
Last Name:BEAUVAIS
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 103
Mailing Address - Street 2:
Mailing Address - City:YUTAN
Mailing Address - State:NE
Mailing Address - Zip Code:68073-0103
Mailing Address - Country:US
Mailing Address - Phone:308-647-6444
Mailing Address - Fax:308-647-6433
Practice Address - Street 1:4600 38TH ST
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:NE
Practice Address - Zip Code:68601-1664
Practice Address - Country:US
Practice Address - Phone:308-647-6444
Practice Address - Fax:308-647-6433
Is Sole Proprietor?:No
Enumeration Date:2006-03-17
Last Update Date:2010-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE180682085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE266872Medicare ID - Type Unspecified
E37935Medicare UPIN