Provider Demographics
NPI:1881763720
Name:BEAUCHAMP, JEREMY TODD (MD)
Entity type:Individual
Prefix:DR
First Name:JEREMY
Middle Name:TODD
Last Name:BEAUCHAMP
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1060 GAFFNEY RD STOP 7440
Mailing Address - Street 2:BASSETT ARMY COMMUNITY HOSPITAL (ATTN MCUC-MMD-QM)
Mailing Address - City:FT WAINWRIGHT
Mailing Address - State:AK
Mailing Address - Zip Code:99703-5007
Mailing Address - Country:US
Mailing Address - Phone:907-361-5603
Mailing Address - Fax:907-361-4847
Practice Address - Street 1:1060 GAFFNEY RD STOP 7440
Practice Address - Street 2:BASSETT ARMY COMMUNITY HOSPITAL (ATTN MCUC-MMD-QM)
Practice Address - City:FT WAINWRIGHT
Practice Address - State:AK
Practice Address - Zip Code:99703-5007
Practice Address - Country:US
Practice Address - Phone:907-361-5603
Practice Address - Fax:907-361-4847
Is Sole Proprietor?:No
Enumeration Date:2006-11-07
Last Update Date:2016-01-14
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Provider Licenses
StateLicense IDTaxonomies
IN01055286A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine