Provider Demographics
NPI:1770573750
Name:BEASLEY, DONALD J (MD)
Entity type:Individual
Prefix:DR
First Name:DONALD
Middle Name:J
Last Name:BEASLEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:8854 W EMERALD ST STE 150
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83704-4844
Mailing Address - Country:US
Mailing Address - Phone:208-229-2368
Mailing Address - Fax:888-815-1651
Practice Address - Street 1:8854 W EMERALD ST STE 150
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83704-4844
Practice Address - Country:US
Practice Address - Phone:208-229-2368
Practice Address - Fax:888-815-1621
Is Sole Proprietor?:No
Enumeration Date:2005-10-21
Last Update Date:2021-05-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IDM-7576207Y00000X
IDM7576207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID040013862OtherRAILROAD MEDICARE
ID000010004823OtherBLUE SHIELD
ID000010004824OtherBLUE SHIELD
IDDM735OtherBLUE CROSS
ID805241200Medicaid
ID38117OtherBLUE CROSS
IDDM735OtherBLUE CROSS
ID000010004824OtherBLUE SHIELD