Provider Demographics
NPI:1689879751
Name:BEACH, HOLLY NOEL (MD)
Entity Type:Individual
Prefix:MRS
First Name:HOLLY
Middle Name:NOEL
Last Name:BEACH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MRS
Other - First Name:HOLLY
Other - Middle Name:GOOD
Other - Last Name:MCNULTY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 2917
Mailing Address - Street 2:BANNER - UNIVERSITY MEDICAL GROUP
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85062-2917
Mailing Address - Country:US
Mailing Address - Phone:970-395-7878
Mailing Address - Fax:970-395-7880
Practice Address - Street 1:2800 E AJO WAY STE 200
Practice Address - Street 2:BANNER - UNIVERSITY MEDICAL GROUP
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85713
Practice Address - Country:US
Practice Address - Phone:520-694-8000
Practice Address - Fax:520-874-4801
Is Sole Proprietor?:No
Enumeration Date:2007-06-19
Last Update Date:2018-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ35375207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ35375OtherSTATE LICENSE
AZP00447250OtherRAILROAD MEDICARE
AZ222954Medicaid
AZ35375OtherSTATE LICENSE