Provider Demographics
NPI:1720031867
Name:BEACON OUTPATIENT PHYSICIANS
Entity Type:Organization
Organization Name:BEACON OUTPATIENT PHYSICIANS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:R
Authorized Official - Last Name:NATEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:786-596-7992
Mailing Address - Street 1:8660 W FLAGLER ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33144-2036
Mailing Address - Country:US
Mailing Address - Phone:305-227-5176
Mailing Address - Fax:305-554-4828
Practice Address - Street 1:8301 NW 12TH ST
Practice Address - Street 2:
Practice Address - City:DORAL
Practice Address - State:FL
Practice Address - Zip Code:33126-1838
Practice Address - Country:US
Practice Address - Phone:305-227-3884
Practice Address - Fax:305-554-4833
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical ServicesGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL34576Medicare ID - Type UnspecifiedGROUP NUMBER