Provider Demographics
NPI:1588617997
Name:LANSDEN, BEVERLY (MD)
Entity Type:Individual
Prefix:DR
First Name:BEVERLY
Middle Name:
Last Name:LANSDEN
Suffix:
Gender:F
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 1810
Mailing Address - Street 2:
Mailing Address - City:GULFPORT
Mailing Address - State:MS
Mailing Address - Zip Code:39502-1810
Mailing Address - Country:US
Mailing Address - Phone:228-867-6062
Mailing Address - Fax:228-867-2598
Practice Address - Street 1:4540 W RAILROAD ST
Practice Address - Street 2:
Practice Address - City:GULFPORT
Practice Address - State:MS
Practice Address - Zip Code:39501-2480
Practice Address - Country:US
Practice Address - Phone:228-867-6062
Practice Address - Fax:228-867-2598
Is Sole Proprietor?:No
Enumeration Date:2006-05-18
Last Update Date:2014-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS13274207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS02301265Medicaid
MSP00406988OtherRAILROAD MEDICARE
MS$$$$$$$$$EOtherBCBS
MSP00406988OtherRAILROAD MEDICARE
MS$$$$$$$$$DOtherBCBS
MS02301265Medicaid
MS$$$$$$$$$EOtherBCBS
MSP00406988OtherRAILROAD MEDICARE