Provider Demographics
NPI:1932386661
Name:JACK E BEEBE MD PA
Entity Type:Organization
Organization Name:JACK E BEEBE MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JACK
Authorized Official - Middle Name:E
Authorized Official - Last Name:BEEBE
Authorized Official - Suffix:
Authorized Official - Credentials:MD PA
Authorized Official - Phone:727-734-6516
Mailing Address - Street 1:1665 NARNIA CT
Mailing Address - Street 2:
Mailing Address - City:DUNEDIN
Mailing Address - State:FL
Mailing Address - Zip Code:34698-2923
Mailing Address - Country:US
Mailing Address - Phone:727-734-6516
Mailing Address - Fax:727-734-4516
Practice Address - Street 1:1665 NARNIA CT
Practice Address - Street 2:
Practice Address - City:DUNEDIN
Practice Address - State:FL
Practice Address - Zip Code:34698-2923
Practice Address - Country:US
Practice Address - Phone:727-734-6516
Practice Address - Fax:727-734-4516
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-24
Last Update Date:2008-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME20500174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty