Provider Demographics
NPI:1720125479
Name:BEACH MEDICAL SPECIALIST PA
Entity Type:Organization
Organization Name:BEACH MEDICAL SPECIALIST PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ALEJANDRO
Authorized Official - Middle Name:CABIGTING
Authorized Official - Last Name:DIZON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:904-200-2978
Mailing Address - Street 1:9860 BEACH BLVD
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32246-4704
Mailing Address - Country:US
Mailing Address - Phone:904-200-2978
Mailing Address - Fax:904-807-9114
Practice Address - Street 1:9860 BEACH BLVD
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32246-4704
Practice Address - Country:US
Practice Address - Phone:904-200-2978
Practice Address - Fax:904-807-9114
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-31
Last Update Date:2024-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME88405207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL272420100Medicaid
FL272420100Medicaid
FLK6664Medicare ID - Type UnspecifiedGROUP ID NUMBER