Provider Demographics
NPI:1750357729
Name:BEAHM, DONALD E (MD)
Entity type:Individual
Prefix:
First Name:DONALD
Middle Name:E
Last Name:BEAHM
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 1:3923 BROADWAY AVE
Mailing Address - Street 2:
Mailing Address - City:GREAT BEND
Mailing Address - State:KS
Mailing Address - Zip Code:67530-3598
Mailing Address - Country:US
Mailing Address - Phone:620-792-3626
Mailing Address - Fax:620-792-1469
Practice Address - Street 1:3923 BROADWAY AVE
Practice Address - Street 2:
Practice Address - City:GREAT BEND
Practice Address - State:KS
Practice Address - Zip Code:67530
Practice Address - Country:US
Practice Address - Phone:620-792-3626
Practice Address - Fax:620-792-1469
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-28
Last Update Date:2018-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04-15025207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100084190AMedicaid
KS001694OtherBLUE CROSS/ BLUE SHIELD
KS181496634Medicare PIN
KS0236540001Medicare NSC
KS001694Medicare PIN
KS100084190AMedicaid