Provider Demographics
NPI:1124115035
Name:BEASLEY, STEPHEN LITTLEFIELD (MD)
Entity type:Individual
Prefix:
First Name:STEPHEN
Middle Name:LITTLEFIELD
Last Name:BEASLEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5000 HENNESSY BLVD
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70808-4375
Mailing Address - Country:US
Mailing Address - Phone:225-765-8853
Mailing Address - Fax:225-765-1700
Practice Address - Street 1:8300 CONSTANTIN BLVD
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70809-3489
Practice Address - Country:US
Practice Address - Phone:225-374-1410
Practice Address - Fax:225-374-1616
Is Sole Proprietor?:No
Enumeration Date:2006-10-10
Last Update Date:2021-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD014137207P00000X, 208000000X, 2080P0204X
TNMD13396208000000X, 2080P0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0204XAllopathic & Osteopathic PhysiciansPediatricsPediatric Emergency Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL009910799Medicaid
AL009940173Medicaid
MS03178354Medicaid
GA000476759BMedicaid
TN4140363OtherBLUE CROSS
TN3011747Medicaid
LA1968374Medicaid
TN3011747Medicare PIN
AL009940173Medicaid
MS03178354Medicaid
255470YJA2Medicare PIN
TN3011747Medicaid