Organization
BLAKE R. BEAZER, M.D., INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. BLAKE RICHARD BEAZER M.D. (MEDICAL DOCTOR)
(435) 882-2358
Entity
Organization
Contact information
Practice address
2356 N 400 E, STE. 201, TOOELE, UT 84074-3409
(435) 882-2350
(435) 882-2039
Mailing address
2356 N 400 E, STE. 201, TOOELE, UT 84074-3409
(435) 882-2350
(435) 882-2039
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
52480801205
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000057289
MEDICARE PTAN
UT
Enumeration date
12/14/2007
Last updated
01/10/2014
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