Provider Demographics
NPI:1962488270
Name:BEAZLEY, ELIZABETH GEORGINA (MD)
Entity Type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:GEORGINA
Last Name:BEAZLEY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1579 VIA OTANO
Mailing Address - Street 2:
Mailing Address - City:OCEANSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92056-5664
Mailing Address - Country:US
Mailing Address - Phone:760-724-4860
Mailing Address - Fax:
Practice Address - Street 1:1579 VIA OTANO
Practice Address - Street 2:
Practice Address - City:OCEANSIDE
Practice Address - State:CA
Practice Address - Zip Code:92056-5664
Practice Address - Country:US
Practice Address - Phone:760-725-1400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-19
Last Update Date:2011-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAGFE83181207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAN68094Medicare UPIN