Provider Demographics
NPI:1740265156
Name:BEASLEY, JOHN JOHNSON (MD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:JOHNSON
Last Name:BEASLEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:132 ARBOR CREST DR
Mailing Address - Street 2:
Mailing Address - City:MAYFIELD
Mailing Address - State:KY
Mailing Address - Zip Code:42066-1233
Mailing Address - Country:US
Mailing Address - Phone:270-247-8710
Mailing Address - Fax:270-247-9564
Practice Address - Street 1:132 ARBOR CREST DR
Practice Address - Street 2:
Practice Address - City:MAYFIELD
Practice Address - State:KY
Practice Address - Zip Code:42066-1233
Practice Address - Country:US
Practice Address - Phone:270-247-8710
Practice Address - Fax:270-247-9564
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-08
Last Update Date:2011-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY250792085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000059857OtherANTHEM BCBS
KY300011148OtherRAILROAD MEDICARE
KY64250798Medicaid
KY300011148OtherRAILROAD MEDICARE
D32897Medicare UPIN