Provider Demographics
NPI:1851427520
Name:BEATTY, ALEXIS LYNN (MD)
Entity Type:Individual
Prefix:
First Name:ALEXIS
Middle Name:LYNN
Last Name:BEATTY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:535 MISSION BAY BLVD S
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94143-2156
Mailing Address - Country:US
Mailing Address - Phone:415-353-2873
Mailing Address - Fax:415-353-2528
Practice Address - Street 1:535 MISSION BAY BLVD S
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94143-2156
Practice Address - Country:US
Practice Address - Phone:415-353-2873
Practice Address - Fax:415-353-2528
Is Sole Proprietor?:No
Enumeration Date:2007-02-26
Last Update Date:2022-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAL-224512207R00000X
CAA106523207R00000X, 207RC0000X
NC2008-00945207R00000X
WA60468292207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine