# BEACH CLINIC INC P S

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

## Provider details

- **NPI number:** 1770787335
- **Authorized official:** SHELLY J DUEBER D.O. (PHYSICIAN)
- **Authorized official phone:** (360) 268-0195

## Contact information

- **Practice address:** 801 N. MONTESANO, WESTPORT, WA 98595
- **Practice address phone:** (360) 268-0195
- **Practice address fax:** (360) 268-1442
- **Mailing address:** 801 N MONTESANO, PO BOX 2229, WESTPORT, WA 98595
- **Mailing address phone:** (360) 268-0195
- **Mailing address fax:** (360) 268-1442

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | OP00001807 | WA | Yes |

## Other

- **Enumeration date:** 06/14/2007
- **Last updated:** 12/07/2010