Provider Demographics
NPI:1396744223
Name:BEECH, RANDALL RENEE (MD)
Entity type:Individual
Prefix:MR
First Name:RANDALL
Middle Name:RENEE
Last Name:BEECH
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:PO BOX 780515
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67278-0515
Mailing Address - Country:US
Mailing Address - Phone:316-636-1129
Mailing Address - Fax:316-218-0681
Practice Address - Street 1:750 AVE D WEST
Practice Address - Street 2:
Practice Address - City:KINGMAN
Practice Address - State:KS
Practice Address - Zip Code:67068-1268
Practice Address - Country:US
Practice Address - Phone:620-532-3147
Practice Address - Fax:620-532-5221
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-21
Last Update Date:2010-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS19302208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS0004070428OtherAETNA
KS020007135OtherRAILROAD MEDICARE
KS100154100BMedicaid
KS017946Medicare ID - Type Unspecified
KS100154100BMedicaid