Provider Demographics
NPI:1700148525
Name:BEAL, TESSA M (MD)
Entity Type:Individual
Prefix:
First Name:TESSA
Middle Name:M
Last Name:BEAL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:TESSA
Other - Middle Name:M
Other - Last Name:LANDA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 4330
Mailing Address - Street 2:
Mailing Address - City:AVON
Mailing Address - State:CO
Mailing Address - Zip Code:81620-4330
Mailing Address - Country:US
Mailing Address - Phone:970-926-6340
Mailing Address - Fax:970-926-6348
Practice Address - Street 1:377 SYLVAN LAKE ROAD
Practice Address - Street 2:SUITE 210
Practice Address - City:EAGLE
Practice Address - State:CO
Practice Address - Zip Code:81631
Practice Address - Country:US
Practice Address - Phone:970-926-6340
Practice Address - Fax:970-926-6348
Is Sole Proprietor?:No
Enumeration Date:2012-06-08
Last Update Date:2023-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO4193207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine