Provider Demographics
NPI:1134179336
Name:BEALS, STEPHEN PAUL (MD)
Entity type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:PAUL
Last Name:BEALS
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 1:5410 N SCOTTSDALE RD
Mailing Address - Street 2:SUITE E-400
Mailing Address - City:PARADISE VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:85253-5927
Mailing Address - Country:US
Mailing Address - Phone:480-947-6788
Mailing Address - Fax:602-926-2597
Practice Address - Street 1:5410 N SCOTTSDALE RD
Practice Address - Street 2:SUITE E-400
Practice Address - City:PARADISE VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:85253-5927
Practice Address - Country:US
Practice Address - Phone:480-947-6788
Practice Address - Fax:602-926-2597
Is Sole Proprietor?:No
Enumeration Date:2006-05-11
Last Update Date:2017-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ15290208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ251835Medicaid
AZ251835Medicaid