Provider Demographics
NPI:1760499396
Name:BEASLEY, GEORGE (DO)
Entity Type:Individual
Prefix:
First Name:GEORGE
Middle Name:
Last Name:BEASLEY
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 121369
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76121-1369
Mailing Address - Country:US
Mailing Address - Phone:817-377-1500
Mailing Address - Fax:817-731-4272
Practice Address - Street 1:3256 LACKLAND RD
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76116-5307
Practice Address - Country:US
Practice Address - Phone:817-377-1500
Practice Address - Fax:817-731-4272
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-03
Last Update Date:2010-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH7882207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
080019357OtherMEDICARE RAILROAD
TX00F98HOtherBCBS
TX11587501Medicaid
TX11587501Medicaid
080019357OtherMEDICARE RAILROAD