Provider Demographics
NPI:1841825791
Name:BEAL DERMATOLOGY, PLLC
Entity type:Organization
Organization Name:BEAL DERMATOLOGY, PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:BRANDON
Authorized Official - Middle Name:T
Authorized Official - Last Name:BEAL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:314-422-6882
Mailing Address - Street 1:6817 SOUTHPOINT PKWY STE 101
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32216-6285
Mailing Address - Country:US
Mailing Address - Phone:904-420-7372
Mailing Address - Fax:904-914-9231
Practice Address - Street 1:6817 SOUTHPOINT PKWY STE 101
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32216-6285
Practice Address - Country:US
Practice Address - Phone:904-420-7372
Practice Address - Fax:904-914-9231
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-10
Last Update Date:2024-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Multi-Specialty
No207NP0225XAllopathic & Osteopathic PhysiciansDermatologyPediatric DermatologyGroup - Multi-Specialty
No207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural DermatologyGroup - Multi-Specialty
No207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic SurgeryGroup - Multi-Specialty
No207ND0900XAllopathic & Osteopathic PhysiciansDermatologyDermatopathologyGroup - Multi-Specialty