Provider Demographics
NPI:1891744132
Name:BEAM, LESLIE A (PA)
Entity Type:Individual
Prefix:
First Name:LESLIE
Middle Name:A
Last Name:BEAM
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3313 ORLANDO ST
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77093-4854
Mailing Address - Country:US
Mailing Address - Phone:713-699-9177
Mailing Address - Fax:
Practice Address - Street 1:3313 ORLANDO ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77093-4854
Practice Address - Country:US
Practice Address - Phone:713-699-9177
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-05
Last Update Date:2018-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3346363A00000X
TXPA05450363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ3346OtherPHYSICIAN ASSIST. LIC.