# RANDY S.BEALLIS D.O. P.A.

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1447483185
- **Authorized official:** DR. RANDY S BEALLIS D.O. (OWNER)
- **Authorized official phone:** (479) 459-5382

## Contact information

- **Practice address:** 7301 ROGERS AVE FL 4, FORT SMITH, AR 72903-4100
- **Practice address phone:** (479) 646-5700
- **Practice address fax:** (479) 646-5956
- **Mailing address:** PO BOX 11106, FORT SMITH, AR 72917-1106
- **Mailing address phone:** (479) 459-5382

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207QA0505X | Adult Medicine Physician | MC-2708 | AR | Yes |

## Other

- **Enumeration date:** 08/28/2009
- **Last updated:** 11/04/2021