Provider Demographics
NPI:1952473431
Name:BEAULIEU, PHILLIP L JR (MD)
Entity Type:Individual
Prefix:DR
First Name:PHILLIP
Middle Name:L
Last Name:BEAULIEU
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:PMB #382
Mailing Address - Street 2:5133 HARDING PIKE, B-10
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37205-2891
Mailing Address - Country:US
Mailing Address - Phone:615-815-1560
Mailing Address - Fax:615-610-1199
Practice Address - Street 1:310 25TH AVE N STE 203
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37203-1593
Practice Address - Country:US
Practice Address - Phone:615-815-1560
Practice Address - Fax:615-610-1199
Is Sole Proprietor?:No
Enumeration Date:2006-11-14
Last Update Date:2022-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN45139208VP0000X, 208VP0014X, 207LP2900X, 207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
No208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain Medicine
No208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1516715Medicaid