Individual
ETHEL S BEASLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
12703
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00111151
—
MS
01
—
009974375
MEDICAID OF AL
AL
01
—
73014344
BLUE CROSS OF AL
—
Enumeration date
07/28/2005
Last updated
09/02/2014
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