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Individual
MR. KELLY DEAN BEAUMONT
Active
Individual
MR. KELLY DEAN BEAUMONT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Taxonomy
Speciality
Code
Description
License number
State
2080A0000X
Pediatric Adolescent Medicine Physician
Primary
100872-1206
UT
Other
Enumeration date
09/21/2006
Last updated
07/08/2007
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