Provider Demographics
NPI:1821093170
Name:BEAMER, WILSON C (MD)
Entity Type:Individual
Prefix:
First Name:WILSON
Middle Name:C
Last Name:BEAMER
Suffix:
Gender:M
Credentials:MD
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Other - First Name:
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Mailing Address - Street 1:501 20TH ST
Mailing Address - Street 2:SUITE 606
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37916-1809
Mailing Address - Country:US
Mailing Address - Phone:865-546-8040
Mailing Address - Fax:865-541-2787
Practice Address - Street 1:501 20TH ST
Practice Address - Street 2:STE 606
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37916-1863
Practice Address - Country:US
Practice Address - Phone:865-546-8040
Practice Address - Fax:865-541-2787
Is Sole Proprietor?:No
Enumeration Date:2005-06-14
Last Update Date:2010-06-03
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TN16813207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN050011295OtherUHC MEDICARE
TN100010198OtherPHP TENNCARE
TN3081811Medicaid
TN2002578OtherBLUE CROSS
TN2002578OtherBLUECARE
TN2002578OtherBLUECARE
TN100010198OtherPHP TENNCARE