Provider Demographics
NPI:1952450280
Name:BEASLEY, BENJAMIN EDWARD (MD)
Entity Type:Individual
Prefix:DR
First Name:BENJAMIN
Middle Name:EDWARD
Last Name:BEASLEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:1233 N 30TH ST
Mailing Address - Street 2:
Mailing Address - City:BILLINGS
Mailing Address - State:MT
Mailing Address - Zip Code:59101-0127
Mailing Address - Country:US
Mailing Address - Phone:406-237-4116
Mailing Address - Fax:406-237-4125
Practice Address - Street 1:1200 COLLEGE DR
Practice Address - Street 2:
Practice Address - City:ROCK SPRINGS
Practice Address - State:WY
Practice Address - Zip Code:82901-5868
Practice Address - Country:US
Practice Address - Phone:307-272-3892
Practice Address - Fax:307-578-8677
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-09
Last Update Date:2020-08-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MT11674207P00000X
WV22228207P00000X
WY7702A207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine