Provider Demographics
NPI:1659324390
Name:BEAMER, LELAND PHILLIPS (MD)
Entity Type:Individual
Prefix:DR
First Name:LELAND
Middle Name:PHILLIPS
Last Name:BEAMER
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 1:76 NE 12TH ST
Mailing Address - Street 2:
Mailing Address - City:MADRAS
Mailing Address - State:OR
Mailing Address - Zip Code:97741-1827
Mailing Address - Country:US
Mailing Address - Phone:541-475-3874
Mailing Address - Fax:541-475-3503
Practice Address - Street 1:76 NE 12TH ST
Practice Address - Street 2:
Practice Address - City:MADRAS
Practice Address - State:OR
Practice Address - Zip Code:97741-1827
Practice Address - Country:US
Practice Address - Phone:541-475-3874
Practice Address - Fax:541-475-3503
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD09240207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR230391Medicaid
OR115894Medicare ID - Type Unspecified
OR230391Medicaid