Provider Demographics
NPI:1578564472
Name:BEECROFT, CARL JONATHAN (DPM)
Entity Type:Individual
Prefix:
First Name:CARL
Middle Name:JONATHAN
Last Name:BEECROFT
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15810 S 45TH ST
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85048-7697
Mailing Address - Country:US
Mailing Address - Phone:480-893-1090
Mailing Address - Fax:480-598-1458
Practice Address - Street 1:15810 S 45TH ST
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85048-7697
Practice Address - Country:US
Practice Address - Phone:480-893-1090
Practice Address - Fax:480-598-1458
Is Sole Proprietor?:No
Enumeration Date:2005-08-02
Last Update Date:2011-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ626213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ0653000001OtherDMERC
AZP00423174OtherRAILROAD MC
AZZ116897Medicare PIN
AZ0653000001OtherDMERC