Individual
BLAKE RICHARD BEAZER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2356 N 400 E, STE 201, TOOELE, UT 84074
(435) 882-2350
(435) 882-2039
Mailing address
2356 N 400 E, STE 201, TOOELE, UT 84074
(435) 882-2350
(435) 882-2039
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
5248080-1205
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
D4916
—
UT
Enumeration date
07/06/2005
Last updated
03/21/2014
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