Individual
DR. BRYAN JAMES BEARDSLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
320 WARNER DR, LEWISTON, ID 83501-4441
(208) 743-3523
(208) 746-8471
Mailing address
320 WARNER DR, LEWISTON, ID 83501-4441
(208) 743-3523
(208) 746-8471
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
M9722
ID
207X00000X
Orthopaedic Surgery Physician
MD00044939
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000010159447
REGENCE BLUESHIELD
ID
01
—
76800
BLUECROSS OF IDAHO
ID
05
—
807636400
—
ID
05
—
8169918
—
WA
Enumeration date
07/04/2006
Last updated
06/24/2016
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