# DR. MICHAEL ALAN BEASLEY

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** No

## Provider details

- **NPI number:** 1407183353
- **Gender:** Man
- **Credential:** M.D.

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 2080S0010X | Pediatric Sports Medicine Physician | MD483528 | PA | Yes |

## Other

- **Enumeration date:** 11/13/2009
- **Last updated:** 11/06/2024

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 104285805 | — | PA |
| 01 | — | 247169 | MASSACHUSETTS LICENSE | MA |
| 05 | — | 525196 | — | AZ |
| 01 | — | 900001779 | EMPLOYEE NUMBER | AZ |