Provider Demographics
NPI:1922056159
Name:BEEZLEY, ALVIN RAY JR (D O)
Entity Type:Individual
Prefix:DR
First Name:ALVIN
Middle Name:RAY
Last Name:BEEZLEY
Suffix:JR
Gender:M
Credentials:D O
Other - Prefix:DR
Other - First Name:ALVIN
Other - Middle Name:RAY
Other - Last Name:BEEZLEY
Other - Suffix:JR
Other - Last Name Type:Other Name
Other - Credentials:DO
Mailing Address - Street 1:9692 WOLFE RD
Mailing Address - Street 2:
Mailing Address - City:CALEDONIA
Mailing Address - State:MS
Mailing Address - Zip Code:39740-9223
Mailing Address - Country:US
Mailing Address - Phone:662-356-0324
Mailing Address - Fax:662-356-0322
Practice Address - Street 1:9692 WOLF ROAD
Practice Address - Street 2:
Practice Address - City:CALEDONIA
Practice Address - State:MS
Practice Address - Zip Code:39740
Practice Address - Country:US
Practice Address - Phone:662-356-0324
Practice Address - Fax:662-356-0322
Is Sole Proprietor?:No
Enumeration Date:2006-05-04
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS15421207R00000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS07757360Medicaid
MS512I110141OtherMEDICARE PTAN
MS512I110141OtherMEDICARE PTAN
MS512I110141OtherMEDICARE PTAN