Provider Demographics
NPI:1881682177
Name:BEAN, JOSEPH M (MD)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:M
Last Name:BEAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1705 E BROADWAY
Mailing Address - Street 2:SUITE 100
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65201-7166
Mailing Address - Country:US
Mailing Address - Phone:573-874-7800
Mailing Address - Fax:573-443-3627
Practice Address - Street 1:5985 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:HANNIBAL
Practice Address - State:MO
Practice Address - Zip Code:63401-6886
Practice Address - Country:US
Practice Address - Phone:573-406-5800
Practice Address - Fax:573-406-5826
Is Sole Proprietor?:No
Enumeration Date:2005-10-11
Last Update Date:2022-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO1035912085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO209988203Medicaid
388501OtherHEALTHLINK
5132415OtherAETNA
65201A004OtherTRICARE
25496017OtherBCBS OF KC
30805OtherGHP
117825OtherBCBS OF MO
24 01298OtherUNITEDHEALTHCARE
G65259OtherMERCY HEALTH PLANS
MO011012700Medicare PIN
MO209988203Medicaid
KSH388206Medicare PIN
25496017OtherBCBS OF KC
MO253010635Medicare PIN
MO966335236Medicare PIN
5132415OtherAETNA
24 01298OtherUNITEDHEALTHCARE
MO152360075Medicare PIN
MO127530002Medicare PIN