Provider Demographics
NPI:1982999314
Name:BEEMAN, STEPHEN KENN (MD, MPH, FACS)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:KENN
Last Name:BEEMAN
Suffix:
Gender:M
Credentials:MD, MPH, FACS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 40
Mailing Address - Street 2:
Mailing Address - City:MANTACHIE
Mailing Address - State:MS
Mailing Address - Zip Code:38855-0040
Mailing Address - Country:US
Mailing Address - Phone:662-282-4226
Mailing Address - Fax:662-282-7946
Practice Address - Street 1:5681 HIGHWAY 363
Practice Address - Street 2:
Practice Address - City:MANTACHIE
Practice Address - State:MS
Practice Address - Zip Code:38855-7632
Practice Address - Country:US
Practice Address - Phone:662-282-4226
Practice Address - Fax:662-282-7946
Is Sole Proprietor?:No
Enumeration Date:2011-06-14
Last Update Date:2011-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS13262207Q00000X, 2083P0901X, 208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083P0901XAllopathic & Osteopathic PhysiciansPreventive MedicinePublic Health & General Preventive Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00110443Medicaid