Provider Demographics
NPI:1457363053
Name:MACBEATH, BLAIR REID (MD)
Entity Type:Individual
Prefix:MR
First Name:BLAIR
Middle Name:REID
Last Name:MACBEATH
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 1:2701 US HIGHWAY 271 N
Mailing Address - Street 2:
Mailing Address - City:PITTSBURG
Mailing Address - State:TX
Mailing Address - Zip Code:75686-4289
Mailing Address - Country:US
Mailing Address - Phone:903-946-5442
Mailing Address - Fax:903-946-5258
Practice Address - Street 1:2701 US HIGHWAY 271 N
Practice Address - Street 2:
Practice Address - City:PITTSBURG
Practice Address - State:TX
Practice Address - Zip Code:75686-4289
Practice Address - Country:US
Practice Address - Phone:903-946-5442
Practice Address - Fax:903-946-5258
Is Sole Proprietor?:No
Enumeration Date:2006-08-12
Last Update Date:2020-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF8936208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX121457903Medicaid
B24541Medicare UPIN
TX00NB08Medicare ID - Type Unspecified