Provider Demographics
NPI:1740224286
Name:BEAUCHAMP, LUANNA L (MD)
Entity Type:Individual
Prefix:
First Name:LUANNA
Middle Name:L
Last Name:BEAUCHAMP
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:LUANNA
Other - Middle Name:
Other - Last Name:LETTIERI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1804 W HULL ST
Mailing Address - Street 2:
Mailing Address - City:DENISON
Mailing Address - State:TX
Mailing Address - Zip Code:75020-5333
Mailing Address - Country:US
Mailing Address - Phone:207-356-2342
Mailing Address - Fax:
Practice Address - Street 1:6119 MIDTOWN AVE
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72205-5313
Practice Address - Country:US
Practice Address - Phone:501-296-1800
Practice Address - Fax:501-296-1711
Is Sole Proprietor?:No
Enumeration Date:2006-06-15
Last Update Date:2024-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME015151173000000X
PAMD457618207VM0101X
IN01086857207VM0101X
ARE15864207VM0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VM0101XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyMaternal & Fetal Medicine
No173000000XOther Service ProvidersLegal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME174590099Medicaid
MEMM8108Medicare ID - Type Unspecified
ME174590099Medicaid