Provider Demographics
NPI:1598037467
Name:DAVID L. BEATTY DPM PC
Entity Type:Organization
Organization Name:DAVID L. BEATTY DPM PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:L
Authorized Official - Last Name:BEATTY
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:419-399-5679
Mailing Address - Street 1:125 N WATER ST
Mailing Address - Street 2:
Mailing Address - City:PAULDING
Mailing Address - State:OH
Mailing Address - Zip Code:45879-1245
Mailing Address - Country:US
Mailing Address - Phone:419-399-5679
Mailing Address - Fax:419-399-3390
Practice Address - Street 1:125 N WATER ST
Practice Address - Street 2:
Practice Address - City:PAULDING
Practice Address - State:OH
Practice Address - Zip Code:45879-1245
Practice Address - Country:US
Practice Address - Phone:419-399-5679
Practice Address - Fax:419-399-3390
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-07
Last Update Date:2012-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH36001932213EP1101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric MedicineGroup - Single Specialty