Provider Demographics
NPI:1205931292
Name:BEACH, DENNIS RANDALL (MD)
Entity type:Individual
Prefix:
First Name:DENNIS
Middle Name:RANDALL
Last Name:BEACH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:D.
Other - Middle Name:RANDALL
Other - Last Name:BEACH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2002 HOSPITAL WAY
Mailing Address - Street 2:
Mailing Address - City:WHITEFISH
Mailing Address - State:MT
Mailing Address - Zip Code:59937
Mailing Address - Country:US
Mailing Address - Phone:406-862-6436
Mailing Address - Fax:406-862-9978
Practice Address - Street 1:2002 HOSPITAL WAY
Practice Address - Street 2:
Practice Address - City:WHITEFISH
Practice Address - State:MT
Practice Address - Zip Code:59937
Practice Address - Country:US
Practice Address - Phone:406-862-6436
Practice Address - Fax:406-862-9978
Is Sole Proprietor?:No
Enumeration Date:2006-09-14
Last Update Date:2008-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTMT8350207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0000021318Medicaid
MT00001985Medicare ID - Type Unspecified
D26528Medicare UPIN