Provider Demographics
NPI:1922241181
Name:BEACHLER, LAEL J (DPM)
Entity Type:Individual
Prefix:
First Name:LAEL
Middle Name:J
Last Name:BEACHLER
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:777 AVENUE H
Mailing Address - Street 2:
Mailing Address - City:POWELL
Mailing Address - State:WY
Mailing Address - Zip Code:82435-2260
Mailing Address - Country:US
Mailing Address - Phone:307-754-9191
Mailing Address - Fax:307-754-1291
Practice Address - Street 1:777 AVENUE H
Practice Address - Street 2:
Practice Address - City:POWELL
Practice Address - State:WY
Practice Address - Zip Code:82435-2260
Practice Address - Country:US
Practice Address - Phone:307-754-9191
Practice Address - Fax:307-754-1291
Is Sole Proprietor?:No
Enumeration Date:2009-04-16
Last Update Date:2015-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY139213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY5804674OtherCIGNA
WY1245365154OtherMEDICARE GROUP
WYP01142512OtherRAILROAD MEDICARE EMPLOYEE PTAN
WY12407172OtherCAQH
WY133719000Medicaid
WY1245365154OtherMEDICARE GROUP
WYP01142512OtherRAILROAD MEDICARE EMPLOYEE PTAN
WYW24959Medicare PIN