Provider Demographics
NPI:1881645034
Name:BEECHIE, ROGER ALLEN (MD)
Entity type:Individual
Prefix:DR
First Name:ROGER
Middle Name:ALLEN
Last Name:BEECHIE
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 1:129 EL PASO RD.
Mailing Address - Street 2:
Mailing Address - City:RUIDOSO
Mailing Address - State:NM
Mailing Address - Zip Code:88345
Mailing Address - Country:US
Mailing Address - Phone:575-630-8350
Mailing Address - Fax:575-557-4055
Practice Address - Street 1:129 EL PASO RD
Practice Address - Street 2:
Practice Address - City:RUIDOSO
Practice Address - State:NM
Practice Address - Zip Code:88345
Practice Address - Country:US
Practice Address - Phone:575-630-8350
Practice Address - Fax:575-257-4055
Is Sole Proprietor?:No
Enumeration Date:2006-05-12
Last Update Date:2010-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM76-132207Q00000X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM00002808Medicaid
NM2808Medicaid
NM00002808Medicaid
$$$$$$$$$PMedicare PIN
347616701Medicare PIN