Provider Demographics
NPI:1205803327
Name:BEAUCHAMP, D'LIVRO LEMAT (MD)
Entity type:Individual
Prefix:MR
First Name:D'LIVRO
Middle Name:LEMAT
Last Name:BEAUCHAMP
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4705 WOODMERE BLVD
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36106-3078
Mailing Address - Country:US
Mailing Address - Phone:334-558-0262
Mailing Address - Fax:334-558-0267
Practice Address - Street 1:4705 WOODMERE BLVD
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36106-3078
Practice Address - Country:US
Practice Address - Phone:334-558-0262
Practice Address - Fax:334-558-0267
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-07
Last Update Date:2015-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL20243207Q00000X, 207PE0004X, 207QA0401X, 207QA0000X, 207QA0505X, 207QB0002X, 207QG0300X, 208VP0000X, 261QM1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical Services
No207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction Medicine
No207QA0000XAllopathic & Osteopathic PhysiciansFamily MedicineAdolescent Medicine
No207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine
No207QB0002XAllopathic & Osteopathic PhysiciansFamily MedicineObesity Medicine
No207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine
No208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain Medicine
No261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL009987015Medicaid
AL515-21545OtherBCBS ALABAMA
AL515-21545OtherBCBS ALABAMA
AL009987015Medicaid