Provider Demographics
NPI:1619061421
Name:BEAM, JERRY STEPHEN (MD)
Entity Type:Individual
Prefix:DR
First Name:JERRY
Middle Name:STEPHEN
Last Name:BEAM
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 1:231 METHODIST HOSPITAL BLVD
Mailing Address - Street 2:
Mailing Address - City:HATTIESBURG
Mailing Address - State:MS
Mailing Address - Zip Code:39402-1297
Mailing Address - Country:US
Mailing Address - Phone:601-268-8088
Mailing Address - Fax:601-268-8087
Practice Address - Street 1:231 METHODIST HOSPITAL BLVD
Practice Address - Street 2:
Practice Address - City:HATTIESBURG
Practice Address - State:MS
Practice Address - Zip Code:39402-1297
Practice Address - Country:US
Practice Address - Phone:601-268-8088
Practice Address - Fax:601-268-8087
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS10674207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MSB29949Medicare UPIN